Provider Demographics
NPI:1104374297
Name:WACHA, TRAVIS LEE (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:WACHA
Suffix:
Gender:M
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 FM 1990
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-1102
Mailing Address - Country:US
Mailing Address - Phone:903-724-3913
Mailing Address - Fax:
Practice Address - Street 1:4659 FM 1990
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-1162
Practice Address - Country:US
Practice Address - Phone:903-213-2216
Practice Address - Fax:903-213-9233
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131990363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily