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General NPI Number Information
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NPI Number | 1285032367
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Entity Type | Individual
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Provider Name | TRAVIS HOUSEHOLDER PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 3150 N TENAYA WAY STE 260
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City | LAS VEGAS
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State | NV
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Zip | 89128-0459
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Country | US
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Telephone | 702-962-5920
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100744
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City | ATLANTA
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State | GA
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Zip | 30384-6666
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3037
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License Number State | NV
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