Provider Demographics
NPI:1376328807
Name:LANE, TRAVIS KENNETH (CNA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:KENNETH
Last Name:LANE
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 RICHMOND AVE APT 813
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4538
Mailing Address - Country:US
Mailing Address - Phone:314-299-0229
Mailing Address - Fax:
Practice Address - Street 1:9900 RICHMOND AVE APT 813
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4538
Practice Address - Country:US
Practice Address - Phone:314-299-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0060011422376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide