Provider Demographics
NPI:1467096685
Name:STEELE, TRACI LYNNETTE (AGNP-C)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNNETTE
Last Name:STEELE
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 PRIVATE ROAD 7223
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75657-5460
Mailing Address - Country:US
Mailing Address - Phone:903-720-4482
Mailing Address - Fax:
Practice Address - Street 1:801 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5414
Practice Address - Country:US
Practice Address - Phone:903-663-2515
Practice Address - Fax:903-663-2571
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143580363LG0600X, 363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health