Healthcare Provider Details

I. General information

NPI: 1588044846
Provider Name (Legal Business Name): TRACI MCDONALD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 04/23/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MAIN STREET
ELK POINT SD
57025
US

IV. Provider business mailing address

1322 NAVAHO CIR
SIOUX CITY IA
51104-1823
US

V. Phone/Fax

Practice location:
  • Phone: 605-356-3317
  • Fax: 866-423-6811
Mailing address:
  • Phone: 712-490-7933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA085924
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: