1174618458 NPI number — TRACI L HOATSON APRN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174618458 NPI number — TRACI L HOATSON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOATSON
Provider First Name:
TRACI
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLEMENS
Provider Other First Name:
TRACI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174618458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1214 W A ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PLATTE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69101-4695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-221-6228
Provider Business Mailing Address Fax Number:
308-221-6869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214 W A ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLATTE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69101-4695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-221-6228
Provider Business Practice Location Address Fax Number:
308-221-6869
Provider Enumeration Date:
10/04/2006

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:  110464 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: 110464 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 47070592300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47070592305 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47070592302 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01106366 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47070592306 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47070592313 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47066229001 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47070592301 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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