Provider Demographics
NPI:1477903284
Name:KILLIAN, TRACY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2666 BABBLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8334
Mailing Address - Country:US
Mailing Address - Phone:636-379-0209
Mailing Address - Fax:
Practice Address - Street 1:2893 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3526
Practice Address - Country:US
Practice Address - Phone:636-336-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO145843363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care