Provider Demographics
NPI:1124918321
Name:NOVINGER, TRACY (APRN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:NOVINGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 E PATTERSON ST STE 10
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4043
Mailing Address - Country:US
Mailing Address - Phone:660-956-0716
Mailing Address - Fax:660-956-4119
Practice Address - Street 1:1108 E PATTERSON ST STE 10
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4043
Practice Address - Country:US
Practice Address - Phone:660-956-0716
Practice Address - Fax:660-956-4119
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025027322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily