Provider Demographics
NPI:1417941196
Name:CALL-SCHMIDT, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CALL-SCHMIDT
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 1:280 W RIVER PARK DR #200
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-223-4860
Mailing Address - Fax:801-371-8993
Practice Address - Street 1:280 RIVER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5793
Practice Address - Country:US
Practice Address - Phone:801-232-4860
Practice Address - Fax:801-371-8993
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT325608-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS46591Medicare UPIN
UT005582308Medicare ID - Type Unspecified