Provider Demographics
NPI:1477433779
Name:FUENTES, TRAVIS ANDREW (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:ANDREW
Last Name:FUENTES
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SEGUNDO DR
Mailing Address - Street 2:
Mailing Address - City:RUNAWAY BAY
Mailing Address - State:TX
Mailing Address - Zip Code:76426-4513
Mailing Address - Country:US
Mailing Address - Phone:940-393-3814
Mailing Address - Fax:
Practice Address - Street 1:645 E STATE HIGHWAY 121 STE 600
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-7942
Practice Address - Country:US
Practice Address - Phone:972-745-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner