Provider Demographics
NPI:1891368981
Name:DUPAQUIER, TRACY JO (APRN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:JO
Last Name:DUPAQUIER
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 1:313 FEDERAL DR NW STE 130
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-3099
Mailing Address - Country:US
Mailing Address - Phone:812-734-3952
Mailing Address - Fax:812-734-3954
Practice Address - Street 1:313 FEDERAL DR NW STE 130
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-3099
Practice Address - Country:US
Practice Address - Phone:812-734-3952
Practice Address - Fax:812-734-3954
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012541A363LF0000X
KY3016293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3016293OtherMEDICAL LICENSE