Provider Demographics
NPI:1336500578
Name:PATNOUDE, TRACY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:PATNOUDE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21767 PINHOOK RD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MI
Mailing Address - Zip Code:49072-8732
Mailing Address - Country:US
Mailing Address - Phone:269-506-0844
Mailing Address - Fax:
Practice Address - Street 1:960 E STATE ST
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-9339
Practice Address - Country:US
Practice Address - Phone:269-228-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293378163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health