TRAVIS THIBAULT (NPI# 1861990566) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861990566 |
| Entity Type | Individual |
| Full Name | TRAVIS THIBAULT |
| Credential | APRN, NP-C |
| Practice Address |
8438 Timber Ridge Dr De Soto KS 66018-7122 |
| Practice Telephone | 9132609250 |
| Mailing Telephone | 9132609250 |
| Enumeration Date | 2018-01-28 |
| Last Update Date | 2018-01-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
2018001755 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
78038 | KS | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
8438 TIMBER RIDGE DR |
| City | DE SOTO |
| State | KS |
| Zip Code | 66018-7122 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164835823 | Central Medical Laboratory, LLC | Clinical Medical Laboratory | 8960 Commerce Dr, Building 6, De Soto, KS 66018 | 2014-06-10 |
| 1962570713 | James Burdette Boyes | Physician Assistant | 33490 Lexington Avenue, De Soto, KS 66018 | 2006-12-01 |
| 1104908995 | Murdock Health and Wellness Inc | Pharmacy | 34040 Commerce Dr, De Soto, KS 66018 | 2006-10-20 |
| 1801997101 | Hillside Village, LLC | Assisted Living Facility | 33600 W 85th, Desoto, KS 66018 | 2006-09-26 |
| 1619927092 | Charles H Klestinske | Dentist | 32980 W 83rd Street, Desoto, KS 66018 | 2006-05-10 |
| 1811472897 | Lori Ann Murdock | Pharmacist | 34040 Commerce Dr, De Soto, KS 66018 | 2018-09-26 |
| 1558466441 | Don Reith | Chiropractor | 33255 Lexington Ave, Suite B, De Soto, KS 66018-7201 | 2006-09-14 |
| 1154653707 | Stephanie Ann Simon | Physical Therapist | 33255 Lexington Ave, Suite A, De Soto, KS 66018-7201 | 2010-02-08 |
| 1912108531 | Don Reith, Dc, Pa | Chiropractor | 33255 Lexington Ave, Suite B, De Soto, KS 66018-7201 | 2007-05-30 |
| 1104251115 | Pathways and Partnerships, Inc. | Community/Behavioral Health | 8125 Delaware Ter, De Soto, KS 66018-7700 | 2013-09-09 |
| Find all providers in zip 66018 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700495819 | Meghan Jo Shackleton | Nurse Practitioner | 204 N Reed Station Rd, De Soto, IL 62924-1612 | 2020-07-24 |
| 1437605300 | Summer Lorraine Odom | Nurse Practitioner | 140 Gray Moss Rd, De Soto, GA 31743-2218 | 2016-08-30 |
| 1720595200 | Danielle Marie Howerton | Nurse Practitioner | 12 Jefferson Sq, De Soto, MO 63020-1031 | 2018-01-05 |
| 1508264946 | Becky Sue Hammon | Nurse Practitioner | 12 Jefferson Sq, De Soto, MO 63020-1031 | 2014-12-17 |
| 1790037885 | Hattie Debord | Nurse Practitioner | 12 Jefferson Sq, De Soto, MO 63020-1031 | 2012-10-12 |
| 1245522655 | Hometown Healthcare of Desoto LLC | Nurse Practitioner | 106 Easton St, De Soto, MO 63020-1706 | 2011-05-04 |
| 1255324828 | Phillip R Cummings | Nurse Practitioner | 12 Jefferson Sq, De Soto, MO 63020-1031 | 2005-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275132136 | Tina Peck | Nurse Practitioner | 2250 N Rock Rd # 118-266, Wichita, KS 67226-2331 | 2020-10-21 |
| 1407455496 | Edward Mwaura Karanja | Nurse Practitioner | 9121 Schweiger Ct Apt 257, Lenexa, KS 66219-2126 | 2020-10-20 |
| 1467051680 | Debra Kim Lietzke | Nurse Practitioner | 4900 N 126th St, Kansas City, KS 66109-5121 | 2020-10-19 |
| 1487252490 | Angela Lanae Spence | Nurse Practitioner | 618 Garfield St, Clay Center, KS 67432-1823 | 2020-10-12 |
| 1073110482 | Jamely Olaechea | Nurse Practitioner | 8205 E Old Mill Ct, Wichita, KS 67226-4217 | 2020-10-08 |
| 1427655414 | Trent Dylan Befort | Nurse Practitioner | 1012 Green St, Pratt, KS 67124-1311 | 2020-10-03 |
| 1083211031 | Amanda Pierce | Nurse Practitioner | 8717 W 110th St Ste 270, Overland Park, KS 66210-2103 | 2020-10-02 |
| 1902412117 | Davina Rues | Nurse Practitioner | 3876 N Woodlawn Blvd Ste 400, Wichita, KS 67220-2057 | 2020-09-22 |
| 1588270037 | Janie Phillips | Nurse Practitioner | 330 N Vassar St, Wichita, KS 67208-3219 | 2020-09-21 |
| 1437765013 | Anjali Giri | Nurse Practitioner | 9100 E Harry St Apt 1403, Wichita, KS 67207-4850 | 2020-09-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.