Provider Demographics
NPI:1013930759
Name:WESTERFIELD, TRACI (MD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:WESTERFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2925
Mailing Address - Country:US
Mailing Address - Phone:859-278-1316
Mailing Address - Fax:859-278-9896
Practice Address - Street 1:2416 REGENCY ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2954
Practice Address - Country:US
Practice Address - Phone:859-278-1316
Practice Address - Fax:859-276-1574
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33224207P00000X, 207Q00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64057243Medicaid
KYP00104776OtherRR-MEDICARE
KY000000260141OtherANTHEM
KYK151130Medicare PIN
KY64057243Medicaid