Healthcare Provider Details

I. General information

NPI: 1750645545
Provider Name (Legal Business Name): TRACY ROCHELLE WINDHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY ROCHELLE CREAMER, STEVENS FNP-C

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W WHITE ST STE 150
ANNA TX
75409-5159
US

IV. Provider business mailing address

2100 W WHITE ST STE 150
ANNA TX
75409-5155
US

V. Phone/Fax

Practice location:
  • Phone: 972-587-6080
  • Fax: 972-872-8667
Mailing address:
  • Phone: 972-587-6080
  • Fax: 972-872-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP121869
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number599539
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: