Travis Kanaly, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

24574 Issued in OK

Practice address

1705 Renaissance Blvd Ste 120
Edmond, OK 73013

Phone

(405) 844-8572

Fax

(405) 844-9143

NPI assigned

May 7, 2007

Sex

Male

Sole proprietor

No

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)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1750594099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 RENAISSANCE BLVD STE 110",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133084",
            "telephone_number": "405-844-4978",
            "fax_number": "405-844-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 RENAISSANCE BLVD STE 120",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "73013",
            "telephone_number": "405-844-8572",
            "fax_number": "405-844-9143"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3366 NW Expressway Ste 200",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731124416",
            "country_code": "US",
            "telephone_number": "405-713-9930",
            "fax_number": "405-713-9931",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3366 NW Expressway Ste 200",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731124416",
            "country_code": "US",
            "telephone_number": "405-713-9930",
            "fax_number": "405-713-9931",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANALY",
        "first_name": "TRAVIS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OK",
            "license": "24574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Katrina Klohn LPC, P.L.L.C.

• Neurology Physician in Edmond, OK
• Providers in Edmond, OK by specialty
• Neurology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; 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.