Provider Demographics
NPI:1548429293
Name:COMPTON, TRACY (RN, CSA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:COMPTON
Suffix:
Gender:M
Credentials:RN, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 PEAR ORCHARD RD NW
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9455
Mailing Address - Country:US
Mailing Address - Phone:270-735-9434
Mailing Address - Fax:
Practice Address - Street 1:1704 N DIXIE HWY # 913
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9449
Practice Address - Country:US
Practice Address - Phone:419-673-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1092229163W00000X
KYSA165246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant