Provider Demographics
NPI:1467676619
Name:BARNETT, TRACI MICHELLE (NP, CNS)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:MICHELLE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:NP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2579 CHESTNUT BLVD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1026
Mailing Address - Country:US
Mailing Address - Phone:330-929-6596
Mailing Address - Fax:
Practice Address - Street 1:1100 GRAHAM ROAD CIR
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2933
Practice Address - Country:US
Practice Address - Phone:330-926-5701
Practice Address - Fax:330-923-6370
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNPO06955363LA2200X
OHNS06824364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2444911Medicaid