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General NPI Number Information
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NPI Number | 1295586196
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Entity Type | Individual
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Provider Name | TRACI BLACKBURN FNP
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Gender | Female
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 643 I45 S. BUILDING A
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City | HUNTSVILLE
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State | TX
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Zip | 77340
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Country | US
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Telephone | 281-975-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 643 I45 S. BUILDING A
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City | HUNTSVILLE
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State | TX
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Zip | 77340
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Country | US
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Telephone | 281-975-1000
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1215344
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 888082
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License Number State | TX
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