Provider Demographics
NPI:1326308636
Name:ALLEN, TRACY MATHEWS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MATHEWS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 COUNTY ROAD 2005
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-8709
Mailing Address - Country:US
Mailing Address - Phone:936-298-3088
Mailing Address - Fax:936-298-1986
Practice Address - Street 1:1343 COUNTY ROAD 2005
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-8709
Practice Address - Country:US
Practice Address - Phone:936-298-3088
Practice Address - Fax:936-298-1986
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX605294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily