Provider Demographics
NPI:1851062160
Name:MCKENNA, TRACEY HAWKINS (FNP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:HAWKINS
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WALNUT ST STE C
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2055
Mailing Address - Country:US
Mailing Address - Phone:985-284-2454
Mailing Address - Fax:985-284-2516
Practice Address - Street 1:309 WALNUT ST STE C
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2055
Practice Address - Country:US
Practice Address - Phone:985-284-2454
Practice Address - Fax:985-284-2516
Is Sole Proprietor?:No
Enumeration Date:2021-09-26
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily