Individual
MR. TRAVIS BLAIR MECCARIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1792 ALYSHEBA WAY, STE. 150, LEXINGTON, KY 40509
(859) 685-9776
Mailing address
4161 VICTORIA WAY, LEXINGTON, KY 40515
(859) 494-2331
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
KY
Other
Enumeration date
09/07/2012
Last updated
09/07/2012
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