Provider Demographics
NPI:1225077282
Name:GRAPPE, TRACEY TEBBE (PA)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:TEBBE
Last Name:GRAPPE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:TEBBE
Other - Last Name:COKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:508 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2808
Mailing Address - Country:US
Mailing Address - Phone:936-760-8528
Mailing Address - Fax:936-760-7323
Practice Address - Street 1:508 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2808
Practice Address - Country:US
Practice Address - Phone:936-760-8528
Practice Address - Fax:936-760-7323
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00228363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81N722Medicare PIN