Provider Demographics
NPI:1255466041
Name:THOMAS, TRACY L (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 W COUNTY ROAD 80 S
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-8709
Mailing Address - Country:US
Mailing Address - Phone:765-883-5262
Mailing Address - Fax:765-210-1166
Practice Address - Street 1:1700 DIVIDEND DR
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1572
Practice Address - Country:US
Practice Address - Phone:574-722-7407
Practice Address - Fax:574-735-0429
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002328A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily