Provider Demographics
NPI:1194488148
Name:CARNEY, TRACIE LAINE (CNP)
Entity Type:Individual
Prefix:MISS
First Name:TRACIE
Middle Name:LAINE
Last Name:CARNEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1192 HIGHWAY 115
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-9290
Mailing Address - Country:US
Mailing Address - Phone:318-419-8310
Mailing Address - Fax:
Practice Address - Street 1:4801 JACKSON ST # B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2508
Practice Address - Country:US
Practice Address - Phone:318-266-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA219539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily