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General NPI Number Information
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NPI Number | 1104968171
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Entity Type | Individual
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Provider Name | TRACIE L. KROB FNP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 525 BRANSON LANDING BLVD STE 306
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City | BRANSON
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State | MO
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Zip | 65616-2140
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Country | US
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Telephone | 417-335-7559
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Fax |
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Provider Business Mailing Address
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Address Line | 770 BLACK FOREST LN
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City | BRANSON WEST
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State | MO
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Zip | 65737-7771
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Country | US
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Telephone | 417-894-9194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A004382
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 24908
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 20050063342
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License Number State | MO
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