Provider Demographics
NPI:1164525770
Name:STAPLETON, TRACY NICOLE (MSN WHNP)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:NICOLE
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:MSN WHNP
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:NICOLE
Other - Last Name:STIDHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN WHNP
Mailing Address - Street 1:1962 S PARSLEY LANE
Mailing Address - Street 2:APT B
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-782-6270
Mailing Address - Fax:417-781-0563
Practice Address - Street 1:302 S JOPLIN
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64802
Practice Address - Country:US
Practice Address - Phone:417-781-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000162410363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner