Provider Demographics
NPI:1063884708
Name:WILLARD, TRACI (NP)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:WILLARD
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:17755 S LAVERTY ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-4528
Mailing Address - Country:US
Mailing Address - Phone:620-224-0573
Mailing Address - Fax:
Practice Address - Street 1:12120 STATE LINE RD # 296
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1254
Practice Address - Country:US
Practice Address - Phone:913-302-7183
Practice Address - Fax:888-779-3217
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2025-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO102736363LA2100X
KS53-77126-051363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care