Active NPI
Tracy Lyn Travis
- Speech-Language Pathologist
- Mayfield, KY
National Provider Identifier
1841704129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 3713
- Practice address
- 401 Indiana Ave
Mayfield, KY 42066-1766 - Phone
- (270) 247-0200
- NPI assigned
- Nov 26, 2017
- Last updated
- Nov 26, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 3713 | KY | Primary |
Addresses
Primary practice location
401 Indiana Ave
Mayfield, KY 42066-1766
Mailing address
150 Golo Rd
Mayfield, KY 42066-4853
Phone (270) 705-6098
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3713 | KY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511654400000",
"number": "1841704129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 GOLO RD",
"city": "MAYFIELD",
"state": "KY",
"postal_code": "420664853",
"telephone_number": "270-705-6098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 INDIANA AVE",
"city": "MAYFIELD",
"state": "KY",
"postal_code": "420661766",
"telephone_number": "270-247-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAVIS",
"first_name": "TRACY",
"middle_name": "LYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-26",
"last_updated": "2017-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "KY",
"license": "3713",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mayfield, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.