Provider Demographics
NPI:1255694121
Name:LAWLER-SHORTT, TRACI KAYE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:KAYE
Last Name:LAWLER-SHORTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:KAYE
Other - Last Name:SHORTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:609 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3836
Practice Address - Country:US
Practice Address - Phone:940-627-5921
Practice Address - Fax:940-626-1351
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630971363LA2100X
TXAP121618363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care