Provider Demographics
NPI:1306282819
Name:MEYER, TRACIE KAY (AG-ACNP-BC)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:KAY
Last Name:MEYER
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8626 E 116TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2853
Mailing Address - Country:US
Mailing Address - Phone:815-263-6149
Mailing Address - Fax:877-471-0404
Practice Address - Street 1:8626 E 116TH ST STE 200
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2853
Practice Address - Country:US
Practice Address - Phone:815-263-6149
Practice Address - Fax:877-471-0404
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004674A363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201206290Medicaid
IN065940015Medicare PIN