Provider Demographics
NPI:1861424616
Name:DRUM, TRACI LANE (FNP-C)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LANE
Last Name:DRUM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LANE
Other - Last Name:YEASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:11910 GREENVILLE AVE.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:214-572-1124
Mailing Address - Fax:214-572-7724
Practice Address - Street 1:11910 GREENVILLE AVE.
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:214-572-1124
Practice Address - Fax:214-572-7724
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX502362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS76808Medicare UPIN