Individual
TRAVIS LANE THIBAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8438 TIMBER RIDGE DR, DE SOTO, KS 66018-7122
(913) 260-9250
Mailing address
KANSAS EMERGENCY PHYSICIANS LLC, 9100 W 74TH ST, SHAWNEE MISSION, KS 66204
(913) 260-9250
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2018001755
MO
363LF0000X
Family Nurse Practitioner
Primary
78038
KS
Other
Enumeration date
01/28/2018
Last updated
07/27/2021
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