Healthcare Provider Details

I. General information

NPI: 1871122457
Provider Name (Legal Business Name): TRACY ELIZABETH CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 GREERS FERRY RD
DRASCO AR
72530-9130
US

IV. Provider business mailing address

1710 HARRISON ST
BATESVILLE AR
72501-7303
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-1200
  • Fax: 870-262-6966
Mailing address:
  • Phone: 870-262-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number124240
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: