Individual
TRAVIS BENTLEY AVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9850 W ST LUKES DR, NAMPA, ID 83687-7912
(208) 205-7600
(208) 205-7603
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1583
ID
Other
Enumeration date
10/03/2017
Last updated
01/13/2025
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