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General NPI Number Information
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NPI Number | 1770984064
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Entity Type | Individual
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Provider Name | KRISTIN TRACY PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/06/2014
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 1799 MOUNT MARIAH DR
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City | LAS VEGAS
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State | NV
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Zip | 89106-1501
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Country | US
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Telephone | 702-383-1961
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Fax | 702-319-6147
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Provider Business Mailing Address
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Address Line | 3325 RESEARCH WAY
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City | CARSON CITY
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State | NV
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Zip | 89706-7913
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Country | US
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Telephone | 775-888-6610
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Fax | 775-888-4904
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1552
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License Number State | NV
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