Individual provider Active NPI

Travis Andrew Fuentes, FNP-BC

  • Nurse Practitioner
  • Coppell, TX
National Provider Identifier
1477433779
Registry record updated Sep 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1008233 Issued in TX
Practice address
645 E State Highway 121 Ste 600
Coppell, TX 75019-7942
Phone
(972) 745-7500
NPI assigned
Sep 5, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1008233 TX Primary

Addresses

Primary practice location

645 E State Highway 121 Ste 600
Coppell, TX 75019-7942

Mailing address

725 Segundo Dr
Runaway Bay, TX 76426-4513
Phone (940) 393-3814

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251028003770 TX Practitioner - Nurse Practitioner 1254820434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Primary Health Physicians PLLCGroup PAC ID 7810237740, 240 clinicians

Practice addresses (Care Compare)

3520 NW Centre Dr
Fort Worth, TX 76135-3612
Phone (817) 375-2100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1008233TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Health Physicians, PLLC CurrentSince Nov 17, 2025 Accepting new patients

Locations

645 E State Highway 121
Ste 600
Coppell, TX 75019
Phone (972) 906-8107

2310 W University Dr
#1500
Denton, TX 76201
Phone (940) 220-5901

104 S Main St
Keller, TX 76248
Phone (214) 295-9385

3520 NW Centre Dr
Lake Worth, TX 76135
Phone (817) 375-2100

377 W Campbell Rd
Ste 100
Richardson, TX 75080
Phone (469) 232-2945

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757030400000",
    "number": "1477433779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 SEGUNDO DR",
            "city": "RUNAWAY BAY",
            "state": "TX",
            "postal_code": "764264513",
            "telephone_number": "940-393-3814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 E STATE HIGHWAY 121 STE 600",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750197942",
            "telephone_number": "972-745-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUENTES",
        "first_name": "TRAVIS",
        "middle_name": "ANDREW",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-05",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1008233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coppell, TX

Sources for this page

Verify at the official NPI Registry.