Healthcare Provider Details

I. General information

NPI: 1114841574
Provider Name (Legal Business Name): TRACY ANN VERNON PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 HIGHWAY 17
DELHI LA
71232-7021
US

IV. Provider business mailing address

501 BROADWAY ST
DELHI LA
71232-3001
US

V. Phone/Fax

Practice location:
  • Phone: 318-878-5717
  • Fax: 318-878-5750
Mailing address:
  • Phone: 318-878-6650
  • Fax: 318-878-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number210622
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: