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General NPI Number Information
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NPI Number | 1942020334
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Entity Type | Individual
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Provider Name | TRACY OLONNIE SWEENEY JR.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 110 NW 31ST ST FL 2
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City | LAWTON
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State | OK
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Zip | 73505-6100
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Country | US
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Telephone | 580-357-3671
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Fax |
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Provider Business Mailing Address
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Address Line | 4504 SW PARKWAY DR
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City | LAWTON
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State | OK
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Zip | 73505-8051
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Country | US
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Telephone | 580-591-1831
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 23-585
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License Number State | TX
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