Provider Demographics
NPI:1881917342
Name:CUSHING, TRACY ANN (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:CUSHING
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 SYCAMORE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-3590
Mailing Address - Country:US
Mailing Address - Phone:314-602-2704
Mailing Address - Fax:314-747-3338
Practice Address - Street 1:1034 S BRENTWOOD BLVD STE 1250
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1263
Practice Address - Country:US
Practice Address - Phone:314-328-7958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010010163363LF0000X, 363LF0000X
IL277002208363LP0808X
MO2020030799363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424249100Medicaid
ILENROLLEDMedicaid