Provider Demographics
NPI:1396569281
Name:SKEETER, TRACY DAVIS
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:DAVIS
Last Name:SKEETER
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 1:555 S MANGUM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4689
Mailing Address - Country:US
Mailing Address - Phone:919-358-1961
Mailing Address - Fax:
Practice Address - Street 1:952 BURNING MAPLE LN
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9958
Practice Address - Country:US
Practice Address - Phone:919-358-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8047341343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)