MEDICARE: TRACY PARKER

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1174774665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY PARKER

Provider Business Mailing Address
First Line	:	P.O. BOX 251970
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72225-1970
Country	:	US
Telephone Number	:	501-666-8686
Fax Number	:	501-660-6830

Provider Business Practice Location Address
First Line	:	5800 WEST 10TH. STREET
Second Line	:	SUITE 600
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-1761
Country	:	US
Telephone Number	:	501-660-6817
Fax Number	:	501-660-6825

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

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	01/27/2025

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Directions to “ TRACY PARKER ” Practice Location

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