Provider Demographics
NPI:1871044115
Name:SQUYRES, TRAVIS (APRN)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:SQUYRES
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 1:1400 WSW LOOP 323 STE 60
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7059
Mailing Address - Country:US
Mailing Address - Phone:903-526-4875
Mailing Address - Fax:903-526-4876
Practice Address - Street 1:2737 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-592-6000
Practice Address - Fax:903-592-3224
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily