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General NPI Number Information
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NPI Number | 1568012896
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Entity Type | Individual
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Provider Name | TRACEY FREDERICK APRN
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Gender | Female
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 3602 NORTHGATE CT STE 39
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City | NEW ALBANY
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State | IN
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Zip | 47150-6417
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Country | US
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Telephone | 812-670-5684
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Fax | 812-941-0814
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Provider Business Mailing Address
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Address Line | PO BOX 21890
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City | BELFAST
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State | ME
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Zip | 04915-4115
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Country | US
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Telephone | 502-907-0356
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Fax | 502-919-9780
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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 | 3013585
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License Number State | KY
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