Provider Demographics
NPI:1871122457
Name:CARROLL, TRACY ELIZABETH
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:CARROLL
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 1:1710 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7303
Mailing Address - Country:US
Mailing Address - Phone:870-262-1200
Mailing Address - Fax:
Practice Address - Street 1:60 GREERS FERRY RD
Practice Address - Street 2:
Practice Address - City:DRASCO
Practice Address - State:AR
Practice Address - Zip Code:72530-9130
Practice Address - Country:US
Practice Address - Phone:870-262-1200
Practice Address - Fax:870-262-6966
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124240363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR346415758Medicaid