MEDICARE: TRACIE GIVENS NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP07207	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033459193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACIE GIVENS NP-C

Provider Business Mailing Address
First Line	:	919 HIDDEN RDG
Second Line	:	6TH FLOOR
City	:	IRVING
State	:	TX
Zip	:	75038-3813
Country	:	US
Telephone Number	:	469-282-2711
Fax Number	:	469-282-2609

Provider Business Practice Location Address
First Line	:	3704 NORTH BLVD STE D
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3658
Country	:	US
Telephone Number	:	318-528-3200
Fax Number	:	318-528-3201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	06/15/2015

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