Provider Demographics
NPI:1265312870
Name:MCPHUN, TRAVIS ANDRE (RN)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ANDRE
Last Name:MCPHUN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 CRAIN HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2820
Mailing Address - Country:US
Mailing Address - Phone:301-374-8772
Mailing Address - Fax:
Practice Address - Street 1:2670 CRAIN HWY STE 106
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2820
Practice Address - Country:US
Practice Address - Phone:301-374-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR257445163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health