MEDICARE: MS. KENDALL N TRAVIS CNP

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
1	363LP0200X	Pediatric Nurse Practitioner	1071364	TX

General Provider Information

NPI Number	:	1275269508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KENDALL N TRAVIS CNP

Provider Business Mailing Address
First Line	:	2400 LAKEVIEW DR STE 114
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-1532
Country	:	US
Telephone Number	:	806-803-9552
Fax Number	:	806-803-9557

Provider Business Practice Location Address
First Line	:	1900 SE 34TH AVE UNIT 1800
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79118-6783
Country	:	US
Telephone Number	:	806-351-7540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2022
Last Update Date	:	12/15/2022

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