Healthcare Provider Details

I. General information

NPI: 1710347380
Provider Name (Legal Business Name): TRACY A WHEELER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY A VOGT

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 GLENN HENDREN DR STE 310
LIBERTY MO
64068-3388
US

IV. Provider business mailing address

2609 GLENN HENDREN DR
LIBERTY MO
64068-3313
US

V. Phone/Fax

Practice location:
  • Phone: 816-415-3420
  • Fax: 816-781-3517
Mailing address:
  • Phone: 816-407-4555
  • Fax: 816-407-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2016005730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: