Provider Demographics
NPI:1194405480
Name:GOWAN, TRAVIS ANDREW (AGACNP-BC, RN)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ANDREW
Last Name:GOWAN
Suffix:
Gender:M
Credentials:AGACNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WALTON TRCE S
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4859
Mailing Address - Country:US
Mailing Address - Phone:731-267-0935
Mailing Address - Fax:
Practice Address - Street 1:4320 HARDING PIKE STE 435
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2202
Practice Address - Country:US
Practice Address - Phone:615-385-3704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN191546163W00000X
TN34143363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse