Individual
MARY ANN TRAVILLIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
204 N MAIN ST, ELIZABETHTOWN, KY 42701-1417
(270) 360-1222
(270) 360-0333
Mailing address
204 N MAIN ST, ELIZABETHTOWN, KY 42701-1417
(270) 360-1222
(270) 360-0333
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1106020
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3015476
KY
Other
Enumeration date
05/18/2020
Last updated
12/02/2020
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