Travis Lane Thibault

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

78038 Issued in KS

Practice address

8438 Timber Ridge Dr
De Soto, KS 66018-7122

Phone

(913) 260-9250

NPI assigned

Jan 28, 2018

Last updated

Jul 27, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Emergency Medicine Services of KS, PA

  • Emergency Medicine Physician
  • Overland Park, KS
  • NPI 1649979451
  Medicare reassignment NPD
• Em Specialists PA

  • Emergency Medicine Physician
  • Shawnee Mission, KS
  • NPI 1801112743
  Medicare reassignment
• ER Physicians South PA

  • Emergency Medicine Physician
  • Ottawa, KS
  • NPI 1194100057
  Medicare reassignment

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

{
    "created_epoch": "1517097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1861990566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "KANSAS EMERGENCY PHYSICIANS LLC",
            "address_2": "9100 W 74TH ST",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "66204",
            "telephone_number": "913-260-9250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8438 TIMBER RIDGE DR",
            "city": "DE SOTO",
            "state": "KS",
            "postal_code": "660187122",
            "telephone_number": "913-260-9250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBAULT",
        "first_name": "TRAVIS",
        "middle_name": "LANE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-28",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2018001755",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "78038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Don Reith, D.C.
• Rose R and D
• Reilly Schultz
• Susan Sculley, CPTA
• Mia Talley, PA-C
• Rebecca Christine Thiele, COTA
• Carla Valenzuela
• Kristina T Woods, CPTA

• Family Nurse Practitioner in De Soto, KS
• Providers in De Soto, KS by specialty
• Family Nurse Practitioner in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.