Basic Information
| Provider Information | |||||||||
| NPI: | 1275269508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAVIS | ||||||||
| FirstName: | KENDALL | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 LAKEVIEW DR STE 114 | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791091532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068039552 | ||||||||
| FaxNumber: | 8068039557 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 SE 34TH AVE UNIT 1800 | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791186783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063517540 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2022 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 1071364 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.