Healthcare Provider Details

I. General information

NPI: 1225478019
Provider Name (Legal Business Name): TRACY JO SNOW MILLS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TRACY JO SNOW ALLAN

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14202 S PADRE ISLAND DR STE A
CORPUS CHRISTI TX
78418-6030
US

IV. Provider business mailing address

2900 SAINT MICHAEL DR STE 401
TEXARKANA TX
75503-5211
US

V. Phone/Fax

Practice location:
  • Phone: 361-902-6170
  • Fax: 361-902-6191
Mailing address:
  • Phone: 903-614-5372
  • Fax: 903-614-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDOS1748
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ9250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: