Provider Demographics
NPI:1821588534
Name:KERN, TRAVIS (MACOM)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:KERN
Suffix:
Gender:M
Credentials:MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 SE 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-5346
Mailing Address - Country:US
Mailing Address - Phone:504-451-1739
Mailing Address - Fax:
Practice Address - Street 1:7642 SW CAPITOL HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2437
Practice Address - Country:US
Practice Address - Phone:971-288-5939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC186554171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist