Provider Demographics
NPI:1538606041
Name:NELMS, TRACY JO (MS, SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:JO
Last Name:NELMS
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:JO
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:301 W F ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5201
Mailing Address - Country:US
Mailing Address - Phone:308-535-7100
Mailing Address - Fax:
Practice Address - Street 1:301 W F ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5201
Practice Address - Country:US
Practice Address - Phone:308-535-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist