Provider Demographics
NPI:1437836376
Name:PELLEY, TRAVIS (FNP-C)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:PELLEY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9290 LUECKEMEYER RD
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-6795
Mailing Address - Country:US
Mailing Address - Phone:281-620-2873
Mailing Address - Fax:
Practice Address - Street 1:9290 LUECKEMEYER RD
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-6795
Practice Address - Country:US
Practice Address - Phone:281-620-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily