Healthcare Provider Details

I. General information

NPI: 1205992849
Provider Name (Legal Business Name): TRACY L FREER ANP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 S BAILEY ST SUITE 207
PALMER AK
99645-6330
US

IV. Provider business mailing address

634 S BAILEY ST STE 207
PALMER AK
99645-6360
US

V. Phone/Fax

Practice location:
  • Phone: 907-745-7080
  • Fax: 907-745-6263
Mailing address:
  • Phone: 907-745-7080
  • Fax: 907-745-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number9769
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number241
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: