Provider Demographics
NPI:1629588421
Name:PARSELL, TRACIE JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:JEAN
Last Name:PARSELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-4433
Mailing Address - Country:US
Mailing Address - Phone:928-201-2110
Mailing Address - Fax:
Practice Address - Street 1:2546 E 2ND ST STE 600
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2063
Practice Address - Country:US
Practice Address - Phone:307-265-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY34233.1673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily