MEDICARE: MRS. TRACY R HARWOOD APRN

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	363LA2100X	Acute Care Nurse Practitioner	A03217	AR
2	363LF0000X	Family Nurse Practitioner	A003217	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790926475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY R HARWOOD APRN

Provider Business Mailing Address
First Line	:	3505 S 79TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6250
Country	:	US
Telephone Number	:	479-709-8686
Fax Number	:	479-709-8687

Provider Business Practice Location Address
First Line	:	4105 NEWLON RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72904-2126
Country	:	US
Telephone Number	:	479-974-1270
Fax Number	:	479-974-1271

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

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	01/09/2023

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