Provider Demographics
NPI:1497749428
Name:TRAVIS, SCARLET DENISE (APN)
Entity Type:Individual
Prefix:MRS
First Name:SCARLET
Middle Name:DENISE
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4900
Mailing Address - Country:US
Mailing Address - Phone:479-636-9234
Mailing Address - Fax:479-636-0774
Practice Address - Street 1:500 S 52ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8600
Practice Address - Country:US
Practice Address - Phone:479-254-9662
Practice Address - Fax:479-254-9652
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01448363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U483Medicare ID - Type Unspecified
AR138402758Medicaid