Provider Demographics
NPI:1790926475
Name:HARWOOD, TRACY R (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:R
Last Name:HARWOOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 S 79TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6250
Mailing Address - Country:US
Mailing Address - Phone:479-709-8686
Mailing Address - Fax:479-709-8687
Practice Address - Street 1:4105 NEWLON RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-2126
Practice Address - Country:US
Practice Address - Phone:479-974-1270
Practice Address - Fax:479-974-1271
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03217363LA2100X
ARA003217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200235270AMedicaid
AR178809758Medicaid
AR5V130Medicare PIN