=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205992849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY L FREER ANP, RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 09/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 634 S BAILEY ST SUITE 207
-----------------------------------------------------
City | PALMER
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99645-6330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-745-7080
-----------------------------------------------------
Fax | 907-745-6263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 634 S BAILEY ST STE 207
-----------------------------------------------------
City | PALMER
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99645-6360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-745-7080
-----------------------------------------------------
Fax | 907-745-6263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 9769
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 241
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------