Provider Demographics
NPI:1871669432
Name:TRACY, CARLA Y (CRNA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:Y
Last Name:TRACY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 COUNTY ROAD 6
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645-8813
Mailing Address - Country:US
Mailing Address - Phone:304-638-0295
Mailing Address - Fax:205-322-1851
Practice Address - Street 1:58 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6765
Practice Address - Country:US
Practice Address - Phone:301-252-4900
Practice Address - Fax:304-252-8470
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50590367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001720741OtherBCBS
WV2605295000Medicaid
OH2378154Medicaid
KY74005778Medicaid
KY74005778Medicaid
WV8230593Medicare PIN