Provider Demographics
NPI:1154313666
Name:BIRKNER, TRACY (PA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BIRKNER
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 1:645 NORTH ARLINGTON
Mailing Address - Street 2:SUITE 440
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4451
Mailing Address - Country:US
Mailing Address - Phone:775-770-7622
Mailing Address - Fax:775-770-3683
Practice Address - Street 1:645 NORTH ARLINGTON
Practice Address - Street 2:SUITE 440
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4451
Practice Address - Country:US
Practice Address - Phone:775-770-7622
Practice Address - Fax:775-770-3683
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA684363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002416241Medicaid
NV002416241Medicaid
NVP35793Medicare UPIN