Provider Demographics
NPI:1144457300
Name:MEREDITH, TRACY LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNN
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 ROGERS LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5918
Mailing Address - Country:US
Mailing Address - Phone:314-395-6524
Mailing Address - Fax:
Practice Address - Street 1:1020 ROGERS LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5918
Practice Address - Country:US
Practice Address - Phone:314-395-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009014165163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse