Provider Demographics
NPI:1124676416
Name:MORGAN, TRACY LEANN (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEANN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S BROADWAY AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5268
Mailing Address - Country:US
Mailing Address - Phone:918-721-0016
Mailing Address - Fax:918-564-2719
Practice Address - Street 1:1301 S BROADWAY AVE STE 5
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5268
Practice Address - Country:US
Practice Address - Phone:918-210-0167
Practice Address - Fax:918-564-2719
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily