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NPI Code Detail

MEDICARE: TRAVIS HOUSEHOLDER PA-C

MEDICARE: TRAVIS HOUSEHOLDER PA-C
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
1363A00000XPhysician AssistantPA3037NV

General Provider Information

NPI Number : 1285032367
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS HOUSEHOLDER PA-C
Provider Business Mailing Address
First Line : PO BOX 100744
Second Line :
City : ATLANTA
State : GA
Zip : 30384-6666
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3150 N TENAYA WAY STE 260
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0459
Country : US
Telephone Number : 702-962-5920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2014
Last Update Date : 07/09/2024

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Directions to “ TRAVIS HOUSEHOLDER PA-C” Practice Location

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