Individual
MR. TRAVIS LANE PHILLIPPI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7777 HENNESSY BLVD STE 8001, BATON ROUGE, LA 70808
(225) 490-7224
(225) 490-7223
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0011
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2505
TN
363A00000X
Physician Assistant
Primary
320838
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6028588
BCBST
TN
05
—
Q010359
—
TN
Enumeration date
04/01/2014
Last updated
06/10/2021
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