Provider Demographics
NPI:1750681920
Name:GUM, TRACY THOMAS (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:THOMAS
Last Name:GUM
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512-0618
Mailing Address - Country:US
Mailing Address - Phone:225-936-8990
Mailing Address - Fax:
Practice Address - Street 1:119 FUSELIER RD
Practice Address - Street 2:
Practice Address - City:ARNAUDVILLE
Practice Address - State:LA
Practice Address - Zip Code:70512-6134
Practice Address - Country:US
Practice Address - Phone:225-936-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06308363LF0000X
LARN096007-AP06308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2144871Medicaid