Individual
TRAVIS CHARLES HEADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
850 W IRONWOOD DR STE 202, COEUR D ALENE, ID 83814-4903
(208) 664-2175
(208) 664-1226
Mailing address
850 W IRONWOOD DR, SUITE 202, COEUR D ALENE, ID 83814-4903
(208) 664-2175
(208) 664-1226
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA406
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA406
LICENSE
ID
Enumeration date
08/16/2006
Last updated
03/11/2025
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