Provider Demographics
NPI:1942206834
Name:ROCKEY, TRACY L (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:ROCKEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:SCHURR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3740 UTICA RIDGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1657
Mailing Address - Country:US
Mailing Address - Phone:563-344-7400
Mailing Address - Fax:563-359-9395
Practice Address - Street 1:3740 UTICA RIDGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1657
Practice Address - Country:US
Practice Address - Phone:563-344-7400
Practice Address - Fax:563-359-9395
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA083846363LP0200X, 363LF0000X
IL209-006162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400194596OtherILLINOIS MEDICARE PTAN
IA408010023OtherIOWA MEDICARE PTAN
IAA083846OtherIOWA LICENSE
IL209006162OtherILLINOIS LICENSE
30825OtherWELLMARK HEALTH PLAN
IA1106563Medicaid
IA1106563Medicaid