Basic Information
| Provider Information | |||||||||
| NPI: | 1376177964 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEIST | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 E 2ND ST | ||||||||
| Address2: | |||||||||
| City: | RICHLAND CENTER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535811914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086476321 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 333 E 2ND ST | ||||||||
| Address2: | |||||||||
| City: | RICHLAND CENTER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535811914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6086476321 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2020 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 9974-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.