Healthcare Provider Details

I. General information

NPI: 1538896196
Provider Name (Legal Business Name): TRACY BONEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 BATESVILLE BLVD
SOUTHSIDE AR
72501-7782
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-569-4934
  • Fax: 870-569-4948
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-301-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221401
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: