Provider Demographics
NPI:1417442450
Name:BERNOT, TRAVIS BRENT (APRN)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:BRENT
Last Name:BERNOT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1832
Mailing Address - Country:US
Mailing Address - Phone:620-231-9873
Mailing Address - Fax:620-231-5062
Practice Address - Street 1:101 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-1276
Practice Address - Country:US
Practice Address - Phone:888-777-9170
Practice Address - Fax:620-231-5062
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78256-122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-78256-122OtherKANSAS APRN LISCENS