Individual
MR. TRAVIS RYAN NICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, APRN
Contact information
Practice address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 685-2221
Mailing address
13809 W ALDERNY ST, WICHITA, KS 67235-7040
(620) 727-7537
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
53-76159
KS
Other
Enumeration date
10/24/2013
Last updated
10/24/2013
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