Provider Demographics
NPI:1396227047
Name:AMERSON-RIVERS, TRACY (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:AMERSON-RIVERS
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29210 JACOBS RIVER DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6958
Mailing Address - Country:US
Mailing Address - Phone:870-740-8850
Mailing Address - Fax:
Practice Address - Street 1:2646 S LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2665
Practice Address - Country:US
Practice Address - Phone:832-297-9279
Practice Address - Fax:281-533-8175
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX918590163W00000X
TXAP140072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse