MEDICARE: TRACY RENEE FOLTZ FNP-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	AP130066	TX

General Provider Information

NPI Number	:	1609233535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY RENEE FOLTZ FNP-C

Provider Business Mailing Address
First Line	:	3515 RICHMOND RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-0711
Country	:	US
Telephone Number	:	903-791-9355
Fax Number	:	903-927-1764

Provider Business Practice Location Address
First Line	:	1004 S JEFFERSON AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-4864
Country	:	US
Telephone Number	:	903-717-3418
Fax Number	:	430-222-2145

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

Provider Enumeration Date	:	01/22/2016
Last Update Date	:	11/01/2024

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