MEDICARE: TRACI THOMPSON

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	845457	TX
2	363L00000X	Nurse Practitioner	1072751	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2C3564	OTHER	TX	TEXAS MEDICARE

General Provider Information

NPI Number	:	1922755222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI THOMPSON

Provider Business Mailing Address
First Line	:	PO BOX 208354
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-8354
Country	:	US
Telephone Number	:	512-485-7208
Fax Number	:	844-364-8678

Provider Business Practice Location Address
First Line	:	213 HUNTERS VLG
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-4764
Country	:	US
Telephone Number	:	855-876-7246
Fax Number	:	855-277-5070

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

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/09/2023

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Directions to “ TRACI THOMPSON ” Practice Location

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