Provider Demographics
NPI:1144772708
Name:SLOAN, TRACEY E (APRN)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:E
Last Name:SLOAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:2025 W EVERLY BROTHERS BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-5401
Practice Address - Country:US
Practice Address - Phone:270-377-2600
Practice Address - Fax:270-377-2610
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3010734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100475410Medicaid