Provider Demographics
NPI:1386184729
Name:MCKELTON, TRACEY S
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:S
Last Name:MCKELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HARBOUR POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-2007
Mailing Address - Country:US
Mailing Address - Phone:561-632-0666
Mailing Address - Fax:
Practice Address - Street 1:4200 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4705
Practice Address - Country:US
Practice Address - Phone:561-967-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-05
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2738522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily