Travis Paul Waters, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1722 Issued in CO

Practice address

559 Vincent St
Ste. 102
Peterson AFB, CO 80914-1541

Phone

(719) 556-1131

Fax

(719) 556-1129

NPI assigned

Sep 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1157328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649372145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 TANNER PKWY",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812129418",
            "telephone_number": "719-276-0967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 VINCENT ST",
            "address_2": "STE. 102",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141541",
            "telephone_number": "719-556-1131",
            "fax_number": "719-556-1129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "TRAVIS",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "1722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey A Turner, DPT
• Francesca Vasta-Falldorf, DDS
• Kim Lee Vehige, LCSW
• George Allen Waddell Jr., M.D.
• Monique McWilliams Wall, LCSW
• John Franklin Watkins III, DENTIST DDS
• Irene Ai-Ling Wiles, PH.D.
• Jefferie Michael Wilson, MD
• June Yi, NP-C

• Physician Assistant in Peterson AFB, CO
• Providers in Peterson AFB, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.