Provider Demographics
NPI:1750838256
Name:DARJEAN, TRACY A
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:A
Last Name:DARJEAN
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 1:13214 MYRNA LANE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-1337
Mailing Address - Country:US
Mailing Address - Phone:281-862-8909
Mailing Address - Fax:
Practice Address - Street 1:13214 MYRNA LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-1337
Practice Address - Country:US
Practice Address - Phone:281-862-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46-3356244174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator