Healthcare Provider Details

I. General information

NPI: 1629588421
Provider Name (Legal Business Name): TRACIE JEAN PARSELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 E 2ND ST STE 600
CASPER WY
82609-2063
US

IV. Provider business mailing address

1516 S JEFFERSON ST
CASPER WY
82601-4433
US

V. Phone/Fax

Practice location:
  • Phone: 307-265-4343
  • Fax:
Mailing address:
  • Phone: 928-201-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number34233.1673
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: