Healthcare Provider Details

I. General information

NPI: 1184741779
Provider Name (Legal Business Name): TRACY HESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY WRIGHT

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 KINGSWAY DR
INDIANAPOLIS IN
46205-1521
US

IV. Provider business mailing address

23 S SHERIDAN AVE
INDIANAPOLIS IN
46219-6608
US

V. Phone/Fax

Practice location:
  • Phone: 317-466-1000
  • Fax: 317-466-2000
Mailing address:
  • Phone: 317-466-1000
  • Fax: 317-466-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number27031913A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: