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Individual

TRAVIS JAMES NORTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
1055 N 500 W BLDG A, PROVO, UT 84604-3305
(801) 812-5033
(801) 812-5034
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
363A00000X
Physician Assistant
Primary
8261139-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
1821393539
UT
390200000X
Student in an Organized Health Care Education/Training Program
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1821393539
UT
Enumeration date
01/11/2011
Last updated
09/07/2022
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