Provider Demographics
NPI:1427204981
Name:THIGPEN, TRACY L (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:THIGPEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 S FRY RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8340
Mailing Address - Country:US
Mailing Address - Phone:281-395-3044
Mailing Address - Fax:281-395-3040
Practice Address - Street 1:6825 S FRY RD STE 1200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8340
Practice Address - Country:US
Practice Address - Phone:281-395-3044
Practice Address - Fax:281-395-3040
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133054363LF0000X
CA19418363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEFF.4/9/13-RIALTOMedicaid
CAFONTANA-EFF.6/4/13Medicaid
CAP01282962/DU4034OtherRAILROAD MEDICARE
CAEFF: 5/3/2012Medicaid
CAFONTANA-EFF.6/4/13Medicaid
CAGC827YMedicare PIN