Provider Demographics
NPI:1790450245
Name:LIVINGSTON, TRACI CAROL (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:CAROL
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:CAROL
Other - Last Name:AUXIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:1013 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1013 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4637
Practice Address - Country:US
Practice Address - Phone:304-424-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV110402363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology