Provider Demographics
NPI:1649994245
Name:RICHARDSON, TRACY LYNETTE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNETTE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3183 SUNNYHOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7152
Mailing Address - Country:US
Mailing Address - Phone:513-462-0222
Mailing Address - Fax:
Practice Address - Street 1:6922 OHIO AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3506
Practice Address - Country:US
Practice Address - Phone:513-793-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0032089363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health