Healthcare Provider Details

I. General information

NPI: 1265065353
Provider Name (Legal Business Name): TRACEY LOUISE OWEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 06/28/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 AVALON AVE OFC
MUSCLE SHOALS AL
35661-3283
US

IV. Provider business mailing address

9711 HIGHWAY 64
LEXINGTON AL
35648-3500
US

V. Phone/Fax

Practice location:
  • Phone: 256-386-0808
  • Fax: 256-389-8904
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-108865
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: