Provider Demographics
NPI:1215707005
Name:CHOUINARD, TRACEE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:TRACEE
Middle Name:
Last Name:CHOUINARD
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256937 E 1790 RD
Mailing Address - Street 2:
Mailing Address - City:GERONIMO
Mailing Address - State:OK
Mailing Address - Zip Code:73543-5228
Mailing Address - Country:US
Mailing Address - Phone:602-999-9813
Mailing Address - Fax:
Practice Address - Street 1:5606 SW LEE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9651
Practice Address - Country:US
Practice Address - Phone:580-699-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207449363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics