Provider Demographics
NPI:1306247796
Name:CARTER, TRACEY LYNN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LYNN
Last Name:CARTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1262
Mailing Address - Country:US
Mailing Address - Phone:907-729-8901
Mailing Address - Fax:907-729-6353
Practice Address - Street 1:10 DNR RD
Practice Address - Street 2:
Practice Address - City:MC GRATH
Practice Address - State:AK
Practice Address - Zip Code:99627-0159
Practice Address - Country:US
Practice Address - Phone:907-524-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9399811363LF0000X
AL1-105493163W00000X, 363LF0000X
AK154364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse