Healthcare Provider Details

I. General information

NPI: 1598135808
Provider Name (Legal Business Name): TRACY HOELTING PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 W 18TH ST
LAWRENCE KS
66047-2090
US

IV. Provider business mailing address

1000 CARONDELET DR PROVIDER ENROLLMENT
KANSAS CITY KS
66112-1636
US

V. Phone/Fax

Practice location:
  • Phone: 785-841-6540
  • Fax: 785-841-3129
Mailing address:
  • Phone: 816-943-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1501842
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1501842
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: