MEDICARE: MR. TRAVIS RAY WILBURN FNP-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
1	363LF0000X	Family Nurse Practitioner	671051	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0068NA	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1770513194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRAVIS RAY WILBURN FNP-C

Provider Business Mailing Address
First Line	:	P.O. BOX 1544
Second Line	:
City	:	ALBANY
State	:	TX
Zip	:	76430-1544
Country	:	US
Telephone Number	:	325-762-3661
Fax Number	:	325-762-3859

Provider Business Practice Location Address
First Line	:	450 KENSHALO
Second Line	:
City	:	ALBANY
State	:	TX
Zip	:	76430
Country	:	US
Telephone Number	:	325-762-3661
Fax Number	:	325-762-3859

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	12/09/2020

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