Individual
TRAVIS L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1373 E STATE ROAD 62, MADISON, IN 47250-7328
(812) 801-0609
(812) 801-0276
Mailing address
DEPT 86236, PO BOX 950195, LOUISVILLE, KY 40295-0195
(502) 473-2100
(502) 456-6461
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3004523
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200946180
—
IN
05
—
74009473
—
KY
Enumeration date
12/29/2005
Last updated
11/12/2024
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