Healthcare Provider Details

I. General information

NPI: 1134052590
Provider Name (Legal Business Name): TRACY ANN O'CONNELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 CAPITAL AVE SW STE 302
BATTLE CREEK MI
49015-4187
US

IV. Provider business mailing address

601 JOHN ST
KALAMAZOO MI
49007-5232
US

V. Phone/Fax

Practice location:
  • Phone: 269-979-6333
  • Fax: 269-979-6335
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704286593
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: