Healthcare Provider Details

I. General information

NPI: 1891925756
Provider Name (Legal Business Name): TRACY N KING WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E FLAMINGO RD STE 1071050
LAS VEGAS NV
89119-7427
US

IV. Provider business mailing address

1050 E FLAMINGO RD
LAS VEGAS NV
89119-7427
US

V. Phone/Fax

Practice location:
  • Phone: 702-721-9799
  • Fax: 678-968-2287
Mailing address:
  • Phone: 702-721-9799
  • Fax: 678-968-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number866361
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCOA.10725-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: