| Travis Lee Taylor, FNP-C, CRNFA | |
|
30544 Highway 200 Ste 102, Ponderay, ID 83852-5005 | |
| (208) 265-9817 | |
| Not Available |
| Full Name | Travis Lee Taylor |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner |
| Experience | 12 Years |
| Location | 30544 Highway 200 Ste 102, Ponderay, Idaho |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255597811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163WR0006X | Registered Nurse - Registered Nurse First Assistant | N-37973 (Idaho) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | NP-1376A (Idaho) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Bonner General Hospital | Sandpoint, ID | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Michael R Dibenedetto Md Pllc | 0840385670 | 8 |
| Entity Name | Boundary Community Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1801896683 PECOS PAC ID: 3274583406 Enrollment ID: O20050126000312 |
| Entity Name | Michael R Dibenedetto Md Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083809727 PECOS PAC ID: 0840385670 Enrollment ID: O20071009000187 |
| Mailing Address | Practice Location Address |
|---|---|
| Travis Lee Taylor, FNP-C, CRNFA 335 S Lavina Ave, Sandpoint, ID 83864-1721 Ph: (208) 946-8219 | Travis Lee Taylor, FNP-C, CRNFA 30544 Highway 200 Ste 102, Ponderay, ID 83852-5005 Ph: (208) 265-9817 |
Kathy Gavin, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 30410 Highway 200, Ponderay, ID 83852 Phone: 208-263-1345 Fax: 208-255-5531 | |
Graham Charles Andrews, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 400 Schweitzer Plaza Dr Ste 1, Ponderay, ID 83852 Phone: 208-263-0649 |