Provider Demographics
NPI:1205992849
Name:FREER, TRACY L (ANP, RN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:FREER
Suffix:
Gender:F
Credentials:ANP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 S BAILEY ST
Mailing Address - Street 2:STE 207
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6360
Mailing Address - Country:US
Mailing Address - Phone:907-745-7080
Mailing Address - Fax:907-745-6263
Practice Address - Street 1:634 S BAILEY ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6330
Practice Address - Country:US
Practice Address - Phone:907-745-7080
Practice Address - Fax:907-745-6263
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9769163WP0808X
AK241363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK252309OtherCOMPSYCH
AK416445OtherVALUE OPTION
AK350238000OtherAETNA
AKK152469OtherMEDICARE GROUP
AK2206673OtherCIGNA
45-5503677OtherCOMMERCIAL INSURANCE
AKMH9931Medicaid
AK2206673OtherCIGNA
45-5503677OtherCOMMERCIAL INSURANCE