Healthcare Provider Details

I. General information

NPI: 1043525629
Provider Name (Legal Business Name): TRACY PANKEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2010
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7419 KINGSGATE WAY STE E
WEST CHESTER OH
45069-6517
US

IV. Provider business mailing address

7419 KINGSGATE WAY STE E
WEST CHESTER OH
45069-6517
US

V. Phone/Fax

Practice location:
  • Phone: 513-818-6992
  • Fax: 513-812-7754
Mailing address:
  • Phone: 513-818-6992
  • Fax: 513-812-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.019390
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019390
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN348898
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.019390
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: