Provider Demographics
NPI:1275670358
Name:YARBROUGH, TRACY LYNNETTE (MD PHD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNNETTE
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L Y
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PHD
Mailing Address - Street 1:PO BOX 241373
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0007
Mailing Address - Country:US
Mailing Address - Phone:855-424-4240
Mailing Address - Fax:
Practice Address - Street 1:42 FONTENAY CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9568
Practice Address - Country:US
Practice Address - Phone:855-424-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA310141207U00000X
AZ51564207U00000X
TXP7872207U00000X
CAC55859207U00000X
FLME100797207U00000X
ARE5304207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00405164OtherRAILROAD MEDICARE
AR166002001Medicaid
AR166002001Medicaid