Provider Demographics
NPI:1710494497
Name:STEVENS, TRAVIS JAMES (APRN)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:JAMES
Last Name:STEVENS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-7604
Mailing Address - Country:US
Mailing Address - Phone:937-213-3297
Mailing Address - Fax:
Practice Address - Street 1:901 KENTON STATION DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9609
Practice Address - Country:US
Practice Address - Phone:606-759-5337
Practice Address - Fax:606-759-5337
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011944363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily