Healthcare Provider Details

I. General information

NPI: 1932553476
Provider Name (Legal Business Name): TRACY KNIGHT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E DANIEL DR
MOUNT VERNON MO
65712-9690
US

IV. Provider business mailing address

PO BOX 100
PIERCE CITY MO
65723-2100
US

V. Phone/Fax

Practice location:
  • Phone: 417-476-1013
  • Fax: 417-955-6093
Mailing address:
  • Phone:
  • Fax: 417-476-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10233
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number000011
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: