Provider Demographics
NPI:1225563323
Name:TRANT, TRAVIS
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:TRANT
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 1:5380 OLD BULLARD RD
Mailing Address - Street 2:SUITE 600-264
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3607
Mailing Address - Country:US
Mailing Address - Phone:903-330-6701
Mailing Address - Fax:
Practice Address - Street 1:921 SHILOH RD STE B300
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1434
Practice Address - Country:US
Practice Address - Phone:903-258-9061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion