Provider Demographics
NPI:1346671831
Name:STATEN, TRACY LYNN (BS)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNN
Last Name:STATEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:DOBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1408 NORTH DENVER AVENE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-4632
Mailing Address - Country:US
Mailing Address - Phone:918-728-9627
Mailing Address - Fax:918-732-5307
Practice Address - Street 1:1408 NORTH DENVER AVENE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-4632
Practice Address - Country:US
Practice Address - Phone:918-728-9627
Practice Address - Fax:918-732-5307
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator