MEDICARE: TRACY N KING WHNP-BC

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	363LW0102X	Women's Health Nurse Practitioner	866361	NV
2	363LW0102X	Women's Health Nurse Practitioner	COA.10725-NP	OH

General Provider Information

NPI Number	:	1891925756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY N KING WHNP-BC

Provider Business Mailing Address
First Line	:	1050 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7427
Country	:	US
Telephone Number	:	702-721-9799
Fax Number	:	678-968-2287

Provider Business Practice Location Address
First Line	:	1050 E FLAMINGO RD STE 1071050
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7427
Country	:	US
Telephone Number	:	702-721-9799
Fax Number	:	678-968-2287

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

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	10/31/2025

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