Provider Demographics
NPI:1528639606
Name:COOLEY, TRACY (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:WEBSTER-COOLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, APRN, PMHNP-BC
Mailing Address - Street 1:727 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6430
Mailing Address - Country:US
Mailing Address - Phone:618-509-1723
Mailing Address - Fax:618-433-9299
Practice Address - Street 1:727 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6430
Practice Address - Country:US
Practice Address - Phone:618-509-1723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021028636363LP0808X
IL209023519363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty