Provider Demographics
NPI:1124886866
Name:WILLIAMS, TRACEY N
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:N
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 TUSCAN RD
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8694
Mailing Address - Country:US
Mailing Address - Phone:254-338-5994
Mailing Address - Fax:
Practice Address - Street 1:827 TUSCAN RD
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-8694
Practice Address - Country:US
Practice Address - Phone:254-338-5994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider