Provider Demographics
NPI:1205284544
Name:ENSMINGER, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ENSMINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 E 12TH AVE APT 213
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5271
Mailing Address - Country:US
Mailing Address - Phone:620-794-4046
Mailing Address - Fax:
Practice Address - Street 1:1106 N 155TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-7100
Practice Address - Country:US
Practice Address - Phone:913-662-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS48-1284001OtherCASE MAN