Provider Demographics
NPI:1760736664
Name:KUNICKI, TRAVIS E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:E
Last Name:KUNICKI
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 270321
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-0321
Mailing Address - Country:US
Mailing Address - Phone:832-574-4950
Mailing Address - Fax:
Practice Address - Street 1:1401 ST JOSEPH PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8301
Practice Address - Country:US
Practice Address - Phone:713-757-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant