Provider Demographics
NPI:1861704538
Name:PIRTLE, TRAVONDA DAVIS (PA-C)
Entity type:Individual
Prefix:MS
First Name:TRAVONDA
Middle Name:DAVIS
Last Name:PIRTLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TRAVONDA
Other - Middle Name:MEKIA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5651 FRIST BLVD STE 712
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2061
Mailing Address - Country:US
Mailing Address - Phone:615-872-9966
Mailing Address - Fax:615-872-9967
Practice Address - Street 1:5651 FRIST BLVD STE 712
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2061
Practice Address - Country:US
Practice Address - Phone:615-872-9966
Practice Address - Fax:615-872-9967
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02350363A00000X
TN2824363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101401Medicaid
NC2762621Medicare PIN