Provider Demographics
NPI:1750845145
Name:CARRIER, TRACI L (LPN)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:CARRIER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S LINCOLN ST.
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554
Mailing Address - Country:US
Mailing Address - Phone:806-205-3887
Mailing Address - Fax:
Practice Address - Street 1:115 S LINCOLN ST.
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK65825164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse