Provider Demographics
NPI:1013930759
Name:WESTERFIELD, TRACI JO (MD)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:JO
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 1:1300 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-0337
Mailing Address - Country:US
Mailing Address - Phone:270-297-7332
Mailing Address - Fax:
Practice Address - Street 1:1300 E 9TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0337
Practice Address - Country:US
Practice Address - Phone:859-421-1806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33224207Q00000X, 2083A0300X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000260141OtherANTHEM
KYP00104776OtherRR-MEDICARE
KY64057243Medicaid
KYK151130Medicare PIN
KY64057243Medicaid