Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 18779 | TX |
NPI | 1053850248 |
---|---|
Provider Name | Kimberly Travers |
First Address | Irving, TX 75063-3428 |
Second Address | Irving, TX 75063-3428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2017 |
Last Update Date | 21/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1306952734 | NPI TYPE II FOR TRAVERS ORTHODONTICS PA (01) | TX |