Provider Demographics
NPI:1457084725
Name:ALLEN, TRAVIS GARLEN
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:GARLEN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BENSON PARK DR
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26385-6885
Mailing Address - Country:US
Mailing Address - Phone:304-677-7142
Mailing Address - Fax:
Practice Address - Street 1:85 BENSON PARK DR
Practice Address - Street 2:
Practice Address - City:LOST CREEK
Practice Address - State:WV
Practice Address - Zip Code:26385-6885
Practice Address - Country:US
Practice Address - Phone:304-677-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant