Provider Demographics
NPI:1093728024
Name:HEBERT, TRACEE LYNN (APRN, CFNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACEE
Middle Name:LYNN
Last Name:HEBERT
Suffix:
Gender:F
Credentials:APRN, CFNP
Other - Prefix:MISS
Other - First Name:TRACEE
Other - Middle Name:LYNN
Other - Last Name:KIRCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CFNP
Mailing Address - Street 1:579 TURPS RD
Mailing Address - Street 2:
Mailing Address - City:RAGLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70657-7213
Mailing Address - Country:US
Mailing Address - Phone:337-515-8453
Mailing Address - Fax:
Practice Address - Street 1:579 TURPS RD
Practice Address - Street 2:
Practice Address - City:RAGLEY
Practice Address - State:LA
Practice Address - Zip Code:70657-7213
Practice Address - Country:US
Practice Address - Phone:337-515-8453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1584452Medicaid
LA1584452Medicaid