Provider Demographics
NPI:1710362538
Name:MAST, TRACY (APRN, CPNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MAST
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 HEALTHPLEX DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072
Mailing Address - Country:US
Mailing Address - Phone:405-321-5114
Mailing Address - Fax:405-321-6482
Practice Address - Street 1:3231 HEALTHPLEX DRIVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-321-5114
Practice Address - Fax:405-321-6482
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK09312363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200674180AMedicaid