MEDICARE: SWIFT CREEK MENTAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1003381138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWIFT CREEK MENTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	106 QUARTERPATH
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27518-9791
Country	:	US
Telephone Number	:	919-862-7101
Fax Number	:	919-704-3674

Provider Business Practice Location Address
First Line	:	1100 NW MAYNARD RD STE 140
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-8707
Country	:	US
Telephone Number	:	919-424-0062
Fax Number	:	919-704-3674

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AMY K TRACY
Credential	:	DNP PMHNP-BC
Telephone Number	:	919-424-0062

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	07/28/2023

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