Individual
TRAVIS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1219 W MAIN ST, WEST LIBERTY, KY 41472-2161
(606) 743-4808
(606) 743-4716
Mailing address
PO BOX 690, BEATTYVILLE, KY 41311-0690
(606) 464-0151
(606) 464-0152
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
55502
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100747240
—
KY
Enumeration date
04/27/2018
Last updated
08/16/2024
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