MEDICARE: MS. TRACY LYNETTE RICHARDSON NURSE PRACTITIONER

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	363LG0600X	Gerontology Nurse Practitioner	0032089	OH
2	363LA2200X	Adult Health Nurse Practitioner	0032089	OH

General Provider Information

NPI Number	:	1649994245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY LYNETTE RICHARDSON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	3183 SUNNYHOLLOW LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-7152
Country	:	US
Telephone Number	:	513-462-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 GLENCROSSING WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3360
Country	:	US
Telephone Number	:	513-813-4311
Fax Number	:

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

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	06/08/2026

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