Provider Demographics
NPI:1649489287
Name:CUEVAS, TRACI NICOLE (MD)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:NICOLE
Last Name:CUEVAS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:TACI
Other - Middle Name:N
Other - Last Name:COUNLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2601 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2438
Mailing Address - Country:US
Mailing Address - Phone:785-354-5225
Mailing Address - Fax:785-270-0005
Practice Address - Street 1:2601 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2438
Practice Address - Country:US
Practice Address - Phone:785-354-5225
Practice Address - Fax:785-270-0005
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33694208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002196OtherMEDICARE PTAN
KS200619680CMedicaid
KS30004459300003Medicaid
KSP01129367OtherRR MEDICARE PTAN