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NPI Code Detail

MEDICARE: RANDALL SCOTT TRACY NP-C MSN CNOR RNFA

MEDICARE: RANDALL SCOTT TRACY NP-C MSN CNOR RNFA
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
1363L00000XNurse PractitionerAP135853TX

General Provider Information

NPI Number : 1114429495
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDALL SCOTT TRACY NP-C MSN CNOR RNFA
Provider Business Mailing Address
First Line : 533 RIVERBED DR
Second Line :
City : CROWLEY
State : TX
Zip : 76036-3543
Country : US
Telephone Number : 682-812-0270
Fax Number :
Provider Business Practice Location Address
First Line : 1800 PARK PLACE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1302
Country : US
Telephone Number : 682-703-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2018
Last Update Date : 06/16/2018

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