Provider Demographics
NPI:1194094375
Name:ALPHIN, TRACEY W (PA)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:W
Last Name:ALPHIN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:7920 DARTMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2819
Mailing Address - Country:US
Mailing Address - Phone:239-246-7711
Mailing Address - Fax:
Practice Address - Street 1:2301 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5729
Practice Address - Country:US
Practice Address - Phone:317-847-4366
Practice Address - Fax:833-464-4582
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10001366A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400060597Medicare PIN