Healthcare Provider Details

I. General information

NPI: 1891039574
Provider Name (Legal Business Name): TRACI L KILMARTIN LP, CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 E 3RD ST SUITE 100
CHATTANOOGA TN
37404-2600
US

IV. Provider business mailing address

2108 E 3RD ST STE 100
CHATTANOOGA TN
37404-2623
US

V. Phone/Fax

Practice location:
  • Phone: 423-267-0466
  • Fax:
Mailing address:
  • Phone: 423-493-2395
  • Fax: 423-493-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPRO183
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: