Provider Demographics
NPI:1447660451
Name:TRAVIS, TYSON KELLY (DO)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:KELLY
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21200 S STATE ROUTE Y
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-9101
Mailing Address - Country:US
Mailing Address - Phone:816-738-9229
Mailing Address - Fax:
Practice Address - Street 1:2820 E ROCK HAVEN RD STE 120
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-4413
Practice Address - Country:US
Practice Address - Phone:816-380-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO192433207X00000X
NVSL1000207X00000X
MO2019035084207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery