Healthcare Provider Details

I. General information

NPI: 1447554415
Provider Name (Legal Business Name): MISS THUY KIM TRACY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 CROSSROAD BLVD SUITE 106
BRENTWOOD TN
37027
US

IV. Provider business mailing address

206 WESTFIELD DR
NASHVILLE TN
37221-1404
US

V. Phone/Fax

Practice location:
  • Phone: 615-299-6332
  • Fax:
Mailing address:
  • Phone: 615-600-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: