MEDICARE: TRACY THORNTON

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	163WL0100X	Lactation Consultant (Registered Nurse)	L-47666	TX

General Provider Information

NPI Number	:	1699454702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY THORNTON

Provider Business Mailing Address
First Line	:	2322 GARDEN SQUARE PATH
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1034
Country	:	US
Telephone Number	:	832-928-6465
Fax Number	:

Provider Business Practice Location Address
First Line	:	2322 GARDEN SQUARE PATH
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1034
Country	:	US
Telephone Number	:	832-928-6465
Fax Number	:

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

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	07/17/2023

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Directions to “ TRACY THORNTON ” Practice Location

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