Provider Demographics
NPI:1154555761
Name:JACOBS, TRAVIS LEE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:JACOBS
Suffix:
Gender:
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E 117TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3805
Mailing Address - Country:US
Mailing Address - Phone:315-778-8749
Mailing Address - Fax:
Practice Address - Street 1:10015 N. AMBASSADOR DRIVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1365
Practice Address - Country:US
Practice Address - Phone:816-595-4000
Practice Address - Fax:816-595-4001
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1086052363A00000X
MO363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant