Provider Demographics
NPI:1356814982
Name:MCPIKE, TRAVIS RANDALL (NP-C)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:RANDALL
Last Name:MCPIKE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DR STE 1370
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4300
Mailing Address - Country:US
Mailing Address - Phone:317-837-5570
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:1152 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:IN
Practice Address - Zip Code:46105-9604
Practice Address - Country:US
Practice Address - Phone:765-522-1889
Practice Address - Fax:765-522-3583
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28213528A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse