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General NPI Number Information
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NPI Number | 1225506934
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Entity Type | Individual
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Provider Name | TRAVIS CHRISTOPHER KENNEY
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Gender | Male
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 4544 S LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78745-1500
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Country | US
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Telephone | 512-433-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 4805 LOVELL AVE
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City | FORT WORTH
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State | TX
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Zip | 76107-5326
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Country | US
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Telephone | 817-714-5219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP138484
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License Number State | TX
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