MEDICARE: MR. TRAVIS JAMES LEGRAND FNP-BC

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	363L00000X	Nurse Practitioner	872509	NV

General Provider Information

NPI Number	:	1619742327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRAVIS JAMES LEGRAND FNP-BC

Provider Business Mailing Address
First Line	:	1065 E FLAMINGO RD APT 824
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7438
Country	:	US
Telephone Number	:	337-251-1598
Fax Number	:

Provider Business Practice Location Address
First Line	:	1065 E FLAMINGO RD APT 824
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7438
Country	:	US
Telephone Number	:	702-518-8866
Fax Number	:

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

Provider Enumeration Date	:	11/22/2023
Last Update Date	:	11/22/2023

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