Healthcare Provider Details

I. General information

NPI: 1528517802
Provider Name (Legal Business Name): TRACY B STOKES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 5TH AVE
COLUMBUS GA
31904-8915
US

IV. Provider business mailing address

PO BOX 7335
COLUMBUS GA
31908-7335
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-8780
  • Fax:
Mailing address:
  • Phone: 706-320-3128
  • Fax: 706-320-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN203741
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN203741
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: