Provider Demographics
NPI:1568186468
Name:WILLIAMS, TRAVIS AARON (FNP)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:AARON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E GARFIELD ST LOT 45
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-1580
Mailing Address - Country:US
Mailing Address - Phone:785-248-9219
Mailing Address - Fax:
Practice Address - Street 1:1130 W 4TH ST STE 3203
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1345
Practice Address - Country:US
Practice Address - Phone:785-505-5020
Practice Address - Fax:785-505-5260
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS81369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004875470001Medicaid