MEDICARE: SHERRI A. TRACY CRNA

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	367500000X	Certified Registered Nurse Anesthetist	555900	TX
2	367500000X	Certified Registered Nurse Anesthetist	AP114589	TX

General Provider Information

NPI Number	:	1487626321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRI A. TRACY CRNA

Provider Business Mailing Address
First Line	:	1002 GEMINI ST
Second Line	:	SUITE 128
City	:	HOUSTON
State	:	TX
Zip	:	77058-2746
Country	:	US
Telephone Number	:	281-218-9515
Fax Number	:	281-218-9534

Provider Business Practice Location Address
First Line	:	1002 GEMINI ST
Second Line	:	SUITE 128
City	:	HOUSTON
State	:	TX
Zip	:	77058
Country	:	US
Telephone Number	:	281-218-9515
Fax Number	:	281-218-9534

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

Provider Enumeration Date	:	02/05/2006
Last Update Date	:	07/21/2022

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