Provider Demographics
NPI:1548909807
Name:TRACEY, KRISTEN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:TRACEY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 DRESDEN RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1256
Mailing Address - Country:US
Mailing Address - Phone:740-586-9931
Mailing Address - Fax:
Practice Address - Street 1:2525 MAPLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1896
Practice Address - Country:US
Practice Address - Phone:740-453-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily