Provider Demographics
NPI:1295064798
Name:PRICE, TRACIE (FNP)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SHERIDAN SQ
Mailing Address - Street 2:STE 200
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7479
Mailing Address - Country:US
Mailing Address - Phone:423-247-5553
Mailing Address - Fax:423-247-9254
Practice Address - Street 1:8 SHERIDAN SQ
Practice Address - Street 2:STE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7479
Practice Address - Country:US
Practice Address - Phone:423-247-5553
Practice Address - Fax:423-247-9254
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517513Medicaid
TN103I506493Medicare PIN