Provider Demographics
NPI:1477676450
Name:RIEKER, TRACIE JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:JEAN
Last Name:RIEKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3122 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7255
Mailing Address - Country:US
Mailing Address - Phone:907-864-4625
Mailing Address - Fax:907-313-1540
Practice Address - Street 1:17025 SNOWMOBILE LN STE 102
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7044
Practice Address - Country:US
Practice Address - Phone:907-694-9553
Practice Address - Fax:907-694-9585
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK717363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant