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General NPI Number Information
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NPI Number | 1740552777
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Entity Type | Individual
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Provider Name | TRACY A HITT CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 11133 DUNN ROAD
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City | ST. LOUIS
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State | MO
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Zip | 63136-6119
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Country | US
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Telephone | 314-653-5744
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Fax |
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Provider Business Mailing Address
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Address Line | 505 N. THIRD STREET
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City | SAINT JOSEPH
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State | IL
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Zip | 61873-9567
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Country | US
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Telephone | 217-621-6613
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041321295
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License Number State | IL
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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 | 2008036387
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2012004121
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209009406
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License Number State | IL
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