MEDICARE: MRS. WENDY TURNER TRAVIS NP-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	R855747	MS

General Provider Information

NPI Number	:	1881001568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY TURNER TRAVIS NP-C

Provider Business Mailing Address
First Line	:	PO BOX 4618
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38704-4618
Country	:	US
Telephone Number	:	662-335-1621
Fax Number	:	662-335-8128

Provider Business Practice Location Address
First Line	:	1467 HIGHWAY 1 S
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-7141
Country	:	US
Telephone Number	:	662-335-1621
Fax Number	:	662-335-8128

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

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	07/15/2014

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