Provider Demographics
NPI:1831731066
Name:RICH, TRAVIS ALLEN (APRN)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ALLEN
Last Name:RICH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 RANGE CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:ALLARDT
Mailing Address - State:TN
Mailing Address - Zip Code:38504-5076
Mailing Address - Country:US
Mailing Address - Phone:931-397-6022
Mailing Address - Fax:
Practice Address - Street 1:340 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3855
Practice Address - Country:US
Practice Address - Phone:877-258-8795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26642363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health