Provider Demographics
NPI:1972795664
Name:FARHAR, TRAVIS V (PA-C)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:V
Last Name:FARHAR
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:270-798-8426
Mailing Address - Fax:270-798-8630
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8426
Practice Address - Fax:270-798-8630
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004476A225X00000X
363AS0400X
TN3713363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200970270Medicaid
IN216070TMedicare PIN
IN000000528248OtherBLUE CROSS BLUE SHIELD
KY00807005Medicare PIN
IN000000548220OtherBLUE CROSS BLUE SHIELD
IN255480PMedicare PIN