Healthcare Provider Details

I. General information

NPI: 1740552777
Provider Name (Legal Business Name): TRACY A HITT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN ROAD
ST. LOUIS MO
63136-6119
US

IV. Provider business mailing address

505 N. THIRD STREET
SAINT JOSEPH IL
61873-9567
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-5744
  • Fax:
Mailing address:
  • Phone: 217-621-6613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041321295
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2008036387
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2012004121
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209009406
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: