Provider Demographics
NPI:1861970253
Name:HELLUMS, TRACIE RAE (RN)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:RAE
Last Name:HELLUMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 STATE HIGHWAY 276
Mailing Address - Street 2:
Mailing Address - City:POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75472-5936
Mailing Address - Country:US
Mailing Address - Phone:903-348-6181
Mailing Address - Fax:
Practice Address - Street 1:3904 STATE HIGHWAY 276
Practice Address - Street 2:
Practice Address - City:POINT
Practice Address - State:TX
Practice Address - Zip Code:75472-5936
Practice Address - Country:US
Practice Address - Phone:903-348-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX785654163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse