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General NPI Number Information
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NPI Number | 1225457252
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Entity Type | Individual
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Provider Name | MRS. TRACY KNUTSON
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Gender | Female
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 1704 N DIXIE HWY # 913
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-9449
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Country | US
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Telephone | 270-737-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 2549 SPRINGFIELD RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-6708
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Country | US
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Telephone | 270-401-7391
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | R4676
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License Number State | KY
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