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Individual
TRAVIS J WIES
Active
Individual
TRAVIS J WIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP132187
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363776103
—
TX
01
—
787723
MEDICARE
TX
01
—
P02223412
MEDICARE RAIL ROAD
TX
Enumeration date
01/31/2011
Last updated
10/28/2019
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