Provider Demographics
NPI:1316030570
Name:WEST, TRAVIS LYNN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:LYNN
Last Name:WEST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-5289
Mailing Address - Country:US
Mailing Address - Phone:913-424-4983
Mailing Address - Fax:
Practice Address - Street 1:101 S 1ST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3505
Practice Address - Country:US
Practice Address - Phone:620-365-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00806363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant