Provider Demographics
NPI:1639150238
Name:STUCKEY, TRAVIS A (PA-C)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:A
Last Name:STUCKEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0149
Mailing Address - Country:US
Mailing Address - Phone:828-586-7705
Mailing Address - Fax:828-586-7714
Practice Address - Street 1:81 MEDICAL PARK LOOP
Practice Address - Street 2:SUITE 202
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5291
Practice Address - Country:US
Practice Address - Phone:828-586-7705
Practice Address - Fax:828-586-7714
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP103179363A00000X
SC2013363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP92031Medicare UPIN
NC2758837Medicare PIN