Provider Demographics
NPI:1528244001
Name:TRACI L. NIVENS, M.D., P.A.
Entity type:Organization
Organization Name:TRACI L. NIVENS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-378-3153
Mailing Address - Street 1:6124 W PARKER RD
Mailing Address - Street 2:STE 530
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8122
Mailing Address - Country:US
Mailing Address - Phone:972-378-3153
Mailing Address - Fax:972-378-3154
Practice Address - Street 1:6124 W PARKER RD
Practice Address - Street 2:STE 530
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8122
Practice Address - Country:US
Practice Address - Phone:972-378-3153
Practice Address - Fax:972-378-3154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0033LSOtherBLUE CROSS BLUE SHIELD
TX7708266OtherAETNA
TX7708266OtherAETNA