Provider Demographics
NPI:1497127831
Name:MASON, TRACI S (CRNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:S
Last Name:MASON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:CHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6945 COUNTY HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:AL
Mailing Address - Zip Code:35049-3927
Mailing Address - Country:US
Mailing Address - Phone:205-625-3367
Mailing Address - Fax:205-274-0857
Practice Address - Street 1:6945 COUNTY HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:AL
Practice Address - Zip Code:35049-3927
Practice Address - Country:US
Practice Address - Phone:205-625-3367
Practice Address - Fax:205-274-0857
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-102538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily