Provider Demographics
NPI:1073772273
Name:KLETZING, TRACY (PA)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:KLETZING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4582 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-5144
Mailing Address - Country:US
Mailing Address - Phone:540-772-8052
Mailing Address - Fax:540-772-4508
Practice Address - Street 1:2900 LAMB CIR STE 250
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6345
Practice Address - Country:US
Practice Address - Phone:540-772-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002748363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical