Provider Demographics
NPI:1467767095
Name:KLINE, TRACI L (FNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:KLINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:L
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6996 COUNTY ROAD 326
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:MO
Mailing Address - Zip Code:63461-3119
Mailing Address - Country:US
Mailing Address - Phone:573-769-3710
Mailing Address - Fax:573-769-3753
Practice Address - Street 1:6996 COUNTY ROAD 326
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:MO
Practice Address - Zip Code:63461-3119
Practice Address - Country:US
Practice Address - Phone:573-769-3710
Practice Address - Fax:573-769-3753
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003029335163W00000X
MO2010026980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse