Provider Demographics
NPI:1568623767
Name:THOMASON, TRAVIS KEITH (BSN,CRNFA,MBA)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:KEITH
Last Name:THOMASON
Suffix:
Gender:M
Credentials:BSN,CRNFA,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SAVANNAH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-2918
Mailing Address - Country:US
Mailing Address - Phone:636-244-0704
Mailing Address - Fax:
Practice Address - Street 1:405 SAVANNAH RIDGE DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2918
Practice Address - Country:US
Practice Address - Phone:636-244-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146999163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant