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NPI Code Detail

MEDICARE: TRAVIS WILKERSON

MEDICARE: TRAVIS WILKERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1164957833
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS WILKERSON
Provider Business Mailing Address
First Line : 1924 CONSTANTINOPLE ST
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70115-5318
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2439 MANHATTAN BLVD STE 207
Second Line :
City : HARVEY
State : LA
Zip : 70058-5361
Country : US
Telephone Number : 504-364-8949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2017
Last Update Date : 01/29/2024

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Directions to “ TRAVIS WILKERSON ” Practice Location

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