1164525770 NPI number — MS. TRACY NICOLE STAPLETON MSN WHNP

Table of content: MS. TRACY NICOLE STAPLETON MSN WHNP (NPI 1164525770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164525770 NPI number — MS. TRACY NICOLE STAPLETON MSN WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAPLETON
Provider First Name:
TRACY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STIDHAM
Provider Other First Name:
TRACY
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN WHNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164525770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1962 S PARSLEY LANE
Provider Second Line Business Mailing Address:
APT B
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-782-6270
Provider Business Mailing Address Fax Number:
417-781-0563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 S JOPLIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-781-4788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2006

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: 363L00000X , with the licence number:  2000162410 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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