Provider Demographics
NPI:1043761174
Name:EDWARDS, TRAVOY
Entity Type:Individual
Prefix:
First Name:TRAVOY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 E TROPICANA AVE STE 175B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6507
Mailing Address - Country:US
Mailing Address - Phone:702-893-2002
Mailing Address - Fax:702-369-3334
Practice Address - Street 1:1455 E TROPICANA AVE STE 175B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6507
Practice Address - Country:US
Practice Address - Phone:702-893-2002
Practice Address - Fax:702-369-3334
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator