Provider Demographics
NPI:1174896575
Name:READ, TRAVIS E (MSN)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:E
Last Name:READ
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 N MAJOR DR STE A
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-9684
Mailing Address - Country:US
Mailing Address - Phone:409-333-1272
Mailing Address - Fax:409-333-1278
Practice Address - Street 1:3650 N MAJOR DR STE A
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-9684
Practice Address - Country:US
Practice Address - Phone:409-333-1272
Practice Address - Fax:409-333-1278
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675625363LA2200X
TXAP121548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB159783Medicare PIN