Provider Demographics
NPI:1114769726
Name:SKELTON, TRACEY NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:NICOLE
Last Name:SKELTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2267 OLD HIGHWAY 78
Mailing Address - Street 2:
Mailing Address - City:HICKORY FLAT
Mailing Address - State:MS
Mailing Address - Zip Code:38633-8219
Mailing Address - Country:US
Mailing Address - Phone:662-544-1552
Mailing Address - Fax:
Practice Address - Street 1:550 CRAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-3255
Practice Address - Country:US
Practice Address - Phone:662-274-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily