Provider Demographics
NPI:1891196259
Name:WILLIS, TRACY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:TX
Mailing Address - Zip Code:75966-0930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:504 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2808
Practice Address - Country:US
Practice Address - Phone:936-539-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily