Provider Demographics
NPI:1548598378
Name:TRAVIS, KAYLEE A (LPN)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:A
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1636
Mailing Address - Country:US
Mailing Address - Phone:740-453-9995
Mailing Address - Fax:
Practice Address - Street 1:2875 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1636
Practice Address - Country:US
Practice Address - Phone:740-453-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH124370164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse