Healthcare Provider Details

I. General information

NPI: 1255159927
Provider Name (Legal Business Name): TRACY LYNN WHINERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N WINNSBORO ST
QUITMAN TX
75783-2144
US

IV. Provider business mailing address

117 N WINNSBORO ST
QUITMAN TX
75783-2144
US

V. Phone/Fax

Practice location:
  • Phone: 903-763-6220
  • Fax:
Mailing address:
  • Phone: 903-763-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1176480
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: