Healthcare Provider Details

I. General information

NPI: 1356874259
Provider Name (Legal Business Name): TRACY WORLEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E INDIANA AVE
SPOKANE WA
99207-2313
US

IV. Provider business mailing address

3901 W COURT ST
PASCO WA
99301-2776
US

V. Phone/Fax

Practice location:
  • Phone: 866-907-7721
  • Fax: 509-545-8932
Mailing address:
  • Phone: 509-473-0305
  • Fax: 509-545-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60770492
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number55472
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: