Provider Demographics
NPI:1417026550
Name:BEECHER, TRACY L (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:BEECHER
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 1:4674 40TH AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4501
Mailing Address - Country:US
Mailing Address - Phone:701-552-5855
Mailing Address - Fax:866-728-8316
Practice Address - Street 1:4674 40TH AVE S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4501
Practice Address - Country:US
Practice Address - Phone:701-552-5855
Practice Address - Fax:866-728-8316
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR28756363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19850Medicaid
MN1417026550Medicaid
ND713242Medicare PIN
NDN715262Medicare PIN