Provider Demographics
NPI:1225833163
Name:WHITE, TRACY NICOLE
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:NICOLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 BLACK HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3209
Mailing Address - Country:US
Mailing Address - Phone:308-762-1970
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 247
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-0247
Practice Address - Country:US
Practice Address - Phone:308-763-9384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty