1164497061 NPI number — TRACY LEA WOLFE BIRCHFIELD FNP

Table of content: TRACY LEA WOLFE BIRCHFIELD FNP (NPI 1164497061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164497061 NPI number — TRACY LEA WOLFE BIRCHFIELD FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFE BIRCHFIELD
Provider First Name:
TRACY
Provider Middle Name:
LEA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOLFE
Provider Other First Name:
TRACY
Provider Other Middle Name:
LEA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164497061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HOSPITAL RD
Provider Second Line Business Mailing Address:
CALLER BOX C-268
Provider Business Mailing Address City Name:
CHEROKEE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28719-9253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-497-9163
Provider Business Mailing Address Fax Number:
828-497-1723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPITAL RD
Provider Second Line Business Practice Location Address:
CALLER BOX C-268
Provider Business Practice Location Address City Name:
CHEROKEE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28719-9253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-497-9163
Provider Business Practice Location Address Fax Number:
828-497-1723
Provider Enumeration Date:
02/22/2006

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: 363LF0000X , with the licence number:  RN062503 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 213680 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1164497061 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166HR . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".