Provider Demographics
NPI:1235189622
Name:ROBBINS, TRAVIS W (NP)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:W
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-955-6500
Mailing Address - Fax:208-955-6503
Practice Address - Street 1:1900 W CHINDEN BLVD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6690
Practice Address - Country:US
Practice Address - Phone:208-809-2860
Practice Address - Fax:208-809-2861
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006327207P00000X
IDNP-1014A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9636820Medicaid
P82404Medicare UPIN
WAG8859704Medicare PIN