Healthcare Provider Details

I. General information

NPI: 1417335738
Provider Name (Legal Business Name): TRACY A POWELL APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACY SCOTT RN

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BARRETT BLVD
HENDERSON KY
42420
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-844-8600
  • Fax: 270-844-8610
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005716A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010640
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number3010640
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number71005716A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: