Provider Demographics
NPI:1841446325
Name:WILLIAMS, TRAVIS DAVID (NP)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:DAVID
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:4105 FORT HENRY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2240
Mailing Address - Country:US
Mailing Address - Phone:423-239-1550
Mailing Address - Fax:423-239-1544
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 300 E
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-6450
Practice Address - Fax:423-844-6499
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN13596363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN13596OtherSTATE LICENSE NUMBER
TN33420171Medicaid
TN13596OtherSTATE LICENSE NUMBER
TN0443950003Medicare NSC