Provider Demographics
NPI:1326760885
Name:MEAD STAVE, TRACY D (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:D
Last Name:MEAD STAVE
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 1:49 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1242
Mailing Address - Country:US
Mailing Address - Phone:513-317-4303
Mailing Address - Fax:
Practice Address - Street 1:2001 ANDERSON FERRY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3325
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-246-5724
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017172363LF0000X
OHAPRN.CNP.0031039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily