Provider Demographics
NPI:1043255755
Name:VEARRIER, TRACY L (PA-C)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:VEARRIER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 N 7TH
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-4507
Mailing Address - Country:US
Mailing Address - Phone:701-223-6595
Mailing Address - Fax:
Practice Address - Street 1:2520 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1164
Practice Address - Country:US
Practice Address - Phone:701-223-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q06673Medicare UPIN
ND23987Medicare ID - Type Unspecified