Provider Demographics
NPI:1154711943
Name:FISER, TRACY KAY (APRN)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:KAY
Last Name:FISER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:KAY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2213 BRECKENRIDGE TER
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-6403
Mailing Address - Country:US
Mailing Address - Phone:479-252-1031
Mailing Address - Fax:
Practice Address - Street 1:2213 BRECKENRIDGE TER
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-6403
Practice Address - Country:US
Practice Address - Phone:479-252-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily