Healthcare Provider Details

I. General information

NPI: 1356250781
Provider Name (Legal Business Name): MICHELLE TRACY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 NC-242
BENSON NC
27504
US

IV. Provider business mailing address

8345 RUNNING FERN WAY
WILLOW SPRING NC
27592-3316
US

V. Phone/Fax

Practice location:
  • Phone: 919-894-2011
  • Fax:
Mailing address:
  • Phone: 336-692-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025344
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: