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NPI Code Detail

MEDICARE: TRACEY ANN LUCAS

MEDICARE: TRACEY ANN LUCAS
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
1363L00000XNurse PractitionerCNP0028534OH
2363LF0000XFamily Nurse PractitionerCNP0028534OH
3363LF0000XFamily Nurse Practitioner5017806NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982283149
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY ANN LUCAS
Provider Business Mailing Address
First Line : 120 PADDOCK LN
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-2948
Country : US
Telephone Number : 614-632-8625
Fax Number :
Provider Business Practice Location Address
First Line : 7496 ROCKFISH RD
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28306-8076
Country : US
Telephone Number : 910-424-2905
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2021
Last Update Date : 03/29/2023

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Directions to “ TRACEY ANN LUCAS ” Practice Location

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