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General NPI Number Information
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NPI Number | 1295107084
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Entity Type | Individual
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Provider Name | TRACEY RATHBONE
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Gender | Female
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 380 US 221 HWY N
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City | RUTHERFORDTON
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State | NC
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Zip | 28139-7616
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Country | US
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Telephone | 828-223-6972
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Fax |
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Provider Business Mailing Address
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Address Line | 961 PAINTERS GAP RD
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City | RUTHERFORDTON
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State | NC
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Zip | 28139-9519
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Country | US
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Telephone | 828-223-6972
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | NC LMBT 6127
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 6127
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License Number State | NC
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