Provider Demographics
NPI:1104810985
Name:CHRIST-CLEMENT, TRACY A (PA-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:CHRIST-CLEMENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6729 FALLS OF THE NEUSE ROAD
Mailing Address - Street 2:NORTH RALEIGH MEDICAL CENTER
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-844-4344
Mailing Address - Fax:
Practice Address - Street 1:6729 FALLS OF THE NEUSE ROAD
Practice Address - Street 2:NORTH RALEIGH MEDICAL CENTER
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-844-4344
Practice Address - Fax:919-844-3244
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102919363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752657Medicare ID - Type Unspecified
NCS92558Medicare UPIN