Provider Demographics
NPI:1275269508
Name:TRAVIS, KENDALL N (CNP)
Entity Type:Individual
Prefix:MS
First Name:KENDALL
Middle Name:N
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 LAKEVIEW DR STE 114
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1532
Mailing Address - Country:US
Mailing Address - Phone:806-803-9552
Mailing Address - Fax:806-803-9557
Practice Address - Street 1:1900 SE 34TH AVE UNIT 1800
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-6783
Practice Address - Country:US
Practice Address - Phone:806-351-7540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071364363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics