Provider Demographics
NPI:1538955075
Name:BEVERS, TRAVIS S (PA-STUDENT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:S
Last Name:BEVERS
Suffix:
Gender:M
Credentials:PA-STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 PRIVATE ROAD 7017
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:75117-5225
Mailing Address - Country:US
Mailing Address - Phone:469-964-5386
Mailing Address - Fax:
Practice Address - Street 1:301 SETON PKWY STE 203
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8003
Practice Address - Country:US
Practice Address - Phone:469-964-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program