Individual
TRAVIS TADASHI KANNARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
800 5TH AVE STE 500, FORT WORTH, TX 76104-7304
(817) 250-4280
Mailing address
3500 CAMP BOWIE BLVD, FORT WORTH, TX 76107-2690
(817) 735-2000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA18044
TX
Other
Enumeration date
04/11/2024
Last updated
09/10/2025
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