Provider Demographics
NPI:1356014013
Name:VANDERPOOL, TRACEY LYNN (RNFA)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 DEAUVILLE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2720
Mailing Address - Country:US
Mailing Address - Phone:859-743-3251
Mailing Address - Fax:
Practice Address - Street 1:7777 YANKEE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-3500
Practice Address - Country:US
Practice Address - Phone:859-743-3251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.264753163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse