Individual
TRAVIS RAY EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 782-3700
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 782-3700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1193A
ID
Other
Enumeration date
09/19/2012
Last updated
06/06/2022
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