Provider Demographics
NPI:1003991209
Name:CLASON, TRACY LYNN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:CLASON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP/PMHNP
Mailing Address - Street 1:18208 SE 41ST WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8280
Mailing Address - Country:US
Mailing Address - Phone:360-771-6493
Mailing Address - Fax:
Practice Address - Street 1:108 SE 124TH AVE
Practice Address - Street 2:SUITE 22
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6015
Practice Address - Country:US
Practice Address - Phone:360-882-7603
Practice Address - Fax:360-896-0337
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007537363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health