Provider Demographics
NPI:1780858019
Name:COPE, TRACY A (PNP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:A
Last Name:COPE
Suffix:
Gender:
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412031
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2031
Mailing Address - Country:US
Mailing Address - Phone:636-441-7280
Mailing Address - Fax:636-939-9208
Practice Address - Street 1:11 GARVEY PKWY
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5614
Practice Address - Country:US
Practice Address - Phone:636-441-7280
Practice Address - Fax:636-939-9208
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO155039363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420003482Medicaid