Provider Demographics
NPI:1356874259
Name:WORLEY, TRACY (CNM)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WORLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2776
Mailing Address - Country:US
Mailing Address - Phone:509-473-0305
Mailing Address - Fax:509-545-8932
Practice Address - Street 1:123 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2313
Practice Address - Country:US
Practice Address - Phone:866-907-7721
Practice Address - Fax:509-545-8932
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55472367A00000X
WAAP60770492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife