Healthcare Provider Details

I. General information

NPI: 1144946922
Provider Name (Legal Business Name): TRACI LEEANN ROWLETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18765 RIVERSIDE DR
VANSANT VA
24656-0924
US

IV. Provider business mailing address

PO BOX 462
MAXIE VA
24628-0462
US

V. Phone/Fax

Practice location:
  • Phone: 276-935-2880
  • Fax: 276-935-2889
Mailing address:
  • Phone: 276-531-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185436
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3018632
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: