Provider Demographics
NPI:1417335738
Name:POWELL, TRACY A (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:POWELL
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1200 BARRETT BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420
Practice Address - Country:US
Practice Address - Phone:270-844-8600
Practice Address - Fax:270-844-8610
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010640208VP0014X, 363LF0000X
IN71005716A208VP0014X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201325570Medicaid
KY7100440050Medicaid