MEDICARE: MR. TRACEY LEE SMITH PA-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	363A00000X	Physician Assistant	0090-01776	NC
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	0090001776	NC

General Provider Information

NPI Number	:	1790107357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRACEY LEE SMITH PA-C

Provider Business Mailing Address
First Line	:	7780 BRIER CREEK PARKWAY
Second Line	:	SUITE 200
City	:	RALEIGH
State	:	NC
Zip	:	27617-7869
Country	:	US
Telephone Number	:	919-596-3400
Fax Number	:	919-596-3499

Provider Business Practice Location Address
First Line	:	1970-C WEST ARLINGTON BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27837-5783
Country	:	US
Telephone Number	:	252-317-1195
Fax Number	:	919-317-1111

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

Provider Enumeration Date	:	01/15/2014
Last Update Date	:	02/19/2025

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