Provider Demographics
NPI:1346954450
Name:CRABTREE, TRAVIS A (TN CNA KY CNA)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:A
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:TN CNA KY CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 36
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763
Mailing Address - Country:US
Mailing Address - Phone:865-224-0279
Mailing Address - Fax:
Practice Address - Street 1:220 BROWN WEST DR #C203
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854
Practice Address - Country:US
Practice Address - Phone:865-224-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN120932374U00000X, 376K00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide