Individual
TRAVIS THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3324 FRENCH PARK DR, SUITE D, EDMOND, OK 73034-7269
(405) 715-3610
(405) 715-3612
Mailing address
PO BOX 13618, OKLAHOMA CITY, OK 73113-1618
(405) 715-3610
(405) 715-3612
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
80478
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200292810A
—
OK
Enumeration date
05/17/2010
Last updated
03/14/2011
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