MEDICARE: TRACI MCCLAY APRN-CNP

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	363LG0600X	Gerontology Nurse Practitioner	106186	OK
2	363LA2100X	Acute Care Nurse Practitioner	106186	OK

General Provider Information

NPI Number	:	1255966685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI MCCLAY APRN-CNP

Provider Business Mailing Address
First Line	:	4140 W MEMORIAL RD STE 621
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8365
Country	:	US
Telephone Number	:	405-752-3798
Fax Number	:	405-749-4234

Provider Business Practice Location Address
First Line	:	4140 W MEMORIAL RD STE 621
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8365
Country	:	US
Telephone Number	:	405-752-3798
Fax Number	:	405-749-4234

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

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	02/01/2023

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