MEDICARE: MS. TRACY LYNN STATEN B.S.

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1346671831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY LYNN STATEN B.S.

Provider Business Mailing Address
First Line	:	1408 NORTH DENVER AVENE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-4632
Country	:	US
Telephone Number	:	918-728-9627
Fax Number	:	918-732-5307

Provider Business Practice Location Address
First Line	:	1408 NORTH DENVER AVENE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-4632
Country	:	US
Telephone Number	:	918-728-9627
Fax Number	:	918-732-5307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	10/10/2023

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