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Individual

PORTIA F TRAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
206 LONGWOOD DR, CLINTON, MS 39056-5436
(601) 214-2045
Mailing address
514H E WOODROW WILSON AVE, JACKSON, MS 39216-4538
(601) 713-3900

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R800172
MS

Other

Enumeration date
12/26/2007
Last updated
12/26/2007
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