Provider Demographics
NPI:1942299854
Name:PRESCOTT, TRAVIS L (DC, FNP-C, CRNP)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:L
Last Name:PRESCOTT
Suffix:
Gender:M
Credentials:DC, FNP-C, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:8401 CONNECTICUT AVE PH SUITE
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5822
Practice Address - Country:US
Practice Address - Phone:415-658-6791
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087292363LF0000X
MDR232006363L00000X
AL2126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051531281PREMedicare PIN