Healthcare Provider Details

I. General information

NPI: 1619454220
Provider Name (Legal Business Name): TRACI ANN RIZK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 08/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 N. DOWLEN RD
BEAUMONT TX
77706-7690
US

IV. Provider business mailing address

3460 N. DOWLEN RD
BEAUMONT TX
77706-7690
US

V. Phone/Fax

Practice location:
  • Phone: 409-838-0346
  • Fax: 409-839-3720
Mailing address:
  • Phone: 409-838-0346
  • Fax: 409-839-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number257358
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP138470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: