Healthcare Provider Details

I. General information

NPI: 1881917342
Provider Name (Legal Business Name): TRACY ANN CUSHING PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S BRENTWOOD BLVD STE 1250
RICHMOND HEIGHTS MO
63117-1263
US

IV. Provider business mailing address

331 SYCAMORE POINTE DR
TROY MO
63379-3590
US

V. Phone/Fax

Practice location:
  • Phone: 314-328-7958
  • Fax:
Mailing address:
  • Phone: 314-602-2704
  • Fax: 314-747-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010010163
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277002208
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2020030799
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: