Provider Demographics
NPI:1871533281
Name:TRAVIS, SARAH (RD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1824
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72902-1824
Mailing Address - Country:US
Mailing Address - Phone:479-441-4000
Mailing Address - Fax:479-441-4829
Practice Address - Street 1:1311 S I ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4915
Practice Address - Country:US
Practice Address - Phone:479-441-4000
Practice Address - Fax:479-441-4829
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered