Provider Demographics
NPI:1013650142
Name:DRINKARD, TRACY ANNA
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANNA
Last Name:DRINKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S 50TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-6993
Mailing Address - Country:US
Mailing Address - Phone:515-471-1860
Mailing Address - Fax:
Practice Address - Street 1:640 S 50TH ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-6993
Practice Address - Country:US
Practice Address - Phone:515-471-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-17
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022013383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000000OtherNO NUMBER PROVIDED