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NPI Code Detail

MEDICARE: DR. TRACEY BATES LONG RN, APRN, PHD

MEDICARE: DR. TRACEY BATES LONG RN, APRN, PHD
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
1363LP2300XPrimary Care Nurse Practitioner822517NV

General Provider Information

NPI Number : 1104478551
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACEY BATES LONG RN, APRN, PHD
Provider Business Mailing Address
First Line : 10550 HABERSHAM CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89183-4551
Country : US
Telephone Number : 702-301-9560
Fax Number :
Provider Business Practice Location Address
First Line : 7501 FANNIN ST STE 705
Second Line :
City : HOUSTON
State : TX
Zip : 77054-1958
Country : US
Telephone Number : 713-589-5283
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2019
Last Update Date : 07/15/2019

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