Provider Demographics
NPI:1558971648
Name:ALLEN, TRACY DELOIS
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:DELOIS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 N WELLESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2408
Mailing Address - Country:US
Mailing Address - Phone:316-461-2235
Mailing Address - Fax:
Practice Address - Street 1:2734 N WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2408
Practice Address - Country:US
Practice Address - Phone:316-461-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home