Individual
TRAVIS GLENN WHITESIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
309 SANDERS ST, BURLINGTON, KS 66839-2616
(620) 364-2121
Mailing address
309 SANDERS ST, BURLINGTON, KS 66839-2616
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2019017032
MO
363AM0700X
Medical Physician Assistant
Primary
15-01559
KS
Other
Enumeration date
09/05/2012
Last updated
09/23/2019
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