Healthcare Provider Details

I. General information

NPI: 1174618458
Provider Name (Legal Business Name): TRACI L HOATSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACI CLEMENS

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 W A ST
NORTH PLATTE NE
69101-4695
US

IV. Provider business mailing address

1214 W A ST
NORTH PLATTE NE
69101-4695
US

V. Phone/Fax

Practice location:
  • Phone: 308-221-6228
  • Fax: 308-221-6869
Mailing address:
  • Phone: 308-221-6228
  • Fax: 308-221-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110464
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number110464
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: