1205992849 NPI number — TRACY L FREER ANP, RN

Table of content: (NPI 1851709984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205992849 NPI number — TRACY L FREER ANP, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREER
Provider First Name:
TRACY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205992849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
634 S BAILEY ST
Provider Second Line Business Mailing Address:
STE 207
Provider Business Mailing Address City Name:
PALMER
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99645-6360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-745-7080
Provider Business Mailing Address Fax Number:
907-745-6263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
634 S BAILEY ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99645-6330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-745-7080
Provider Business Practice Location Address Fax Number:
907-745-6263
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0808X , with the licence number:  9769 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 241 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 252309 . This is a "COMPSYCH" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 416445 . This is a "VALUE OPTION" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 350238000 . This is a "AETNA" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: K152469 . This is a "MEDICARE GROUP" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 2206673 . This is a "CIGNA" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 45-5503677 . This is a "COMMERCIAL INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: MH9931 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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