Provider Demographics
NPI:1427829407
Name:STENSON, TRACIE OKEMA
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:OKEMA
Last Name:STENSON
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 1:1605 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-2863
Mailing Address - Country:US
Mailing Address - Phone:601-554-6440
Mailing Address - Fax:
Practice Address - Street 1:1605 W 7TH ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-2863
Practice Address - Country:US
Practice Address - Phone:601-554-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty