Healthcare Provider Details

I. General information

NPI: 1528982519
Provider Name (Legal Business Name): TRACIE LYNN SPAULDING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 GARY ST
FORT SMITH AR
72903-5499
US

IV. Provider business mailing address

4100 GARY ST
FORT SMITH AR
72903-5499
US

V. Phone/Fax

Practice location:
  • Phone: 479-646-7371
  • Fax:
Mailing address:
  • Phone: 479-646-7371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR0134525
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: