Provider Demographics
NPI:1710347380
Name:WHEELER, TRACY A (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:A
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2609 GLENN HENDREN DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3313
Mailing Address - Country:US
Mailing Address - Phone:816-407-4555
Mailing Address - Fax:816-407-2362
Practice Address - Street 1:2521 GLENN HENDREN DR STE 310
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-415-3420
Practice Address - Fax:816-781-3517
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016005730363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care