Individual
ERICKA TRAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
106 S MAIN ST, YAZOO CITY, MS 39194-4008
(601) 214-2009
Mailing address
471 ROOSEVELT ST, CANTON, MS 39046-3535
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
—
—
172A00000X
Driver
Primary
—
—
251E00000X
Home Health Agency
—
—
Other
Enumeration date
03/18/2019
Last updated
06/11/2019
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