Provider Demographics
NPI:1609502814
Name:HURLEY, TRACEY ELEANOR (APRN)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ELEANOR
Last Name:HURLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W 47TH ST STE 514
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1247
Mailing Address - Country:US
Mailing Address - Phone:816-216-7054
Mailing Address - Fax:
Practice Address - Street 1:800 W 47TH ST STE 514
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1247
Practice Address - Country:US
Practice Address - Phone:816-216-7054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-81310-062363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609502814OtherNPI