Provider Demographics
NPI:1952660045
Name:MARTIN, TRACY LYNN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-5221
Mailing Address - Country:US
Mailing Address - Phone:918-825-3777
Mailing Address - Fax:918-825-3776
Practice Address - Street 1:211 S MILL ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-5221
Practice Address - Country:US
Practice Address - Phone:918-825-3777
Practice Address - Fax:918-825-3776
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998144-NP363L00000X
OKR0110549363LF0000X
ARA03634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner