Provider Demographics
NPI:1629681036
Name:SMITH, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SMITH
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 1:2400 BUFFALO GAP RD # 189
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6102
Mailing Address - Country:US
Mailing Address - Phone:313-784-5823
Mailing Address - Fax:
Practice Address - Street 1:2400 BUFFALO GAP RD # 189
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6102
Practice Address - Country:US
Practice Address - Phone:313-784-5823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care