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Travis Lane Thibault
Family Nurse Practitioner in De Soto, Kansas
NPI 1861990566

Travis Lane Thibault is a Family Nurse Practitioner based in Shawnee Mission, KS and is specialized in Family. Travis Lane Thibault practices in De Soto, KS. The NPI Number for Travis Lane Thibault is 1861990566 and holds a License No. 2018001755 (Kansas).

The current practice location address for Travis Lane Thibault is 8438 Timber Ridge Dr, De Soto, KS and can be reached out via phone at 913-260-9250.

Location: 8438 Timber Ridge Dr, De Soto, KS, 66204
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1861990566
Provider Name
Travis Lane Thibault
Credential
Provider Entity Type
Individual
Gender
Male
Address
8438 Timber Ridge Dr, De Soto, KS, 66204
Phone Number
913-260-9250
Fax Number
Provider Enumeration Date
01/28/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
8438 Timber Ridge Dr
City
De Soto
State
Kansas
Zip
66018-7122
Phone Number
913-260-9250
Fax Number
person
Provider Business Mailing Address Details
Address
8438 Timber Ridge Dr
City
De Soto
State
Kansas
Zip
66018-7122
Phone Number
913-260-9250
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
2018001755 (Missouri)
Definition
Definition to come...
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