Provider Demographics
NPI:1528333184
Name:HOWERY, TRACY LYNN (APRN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:HOWERY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 N RIVERSIDE RD
Mailing Address - Street 2:STE. 130
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2502
Mailing Address - Country:US
Mailing Address - Phone:816-271-7673
Mailing Address - Fax:816-271-4924
Practice Address - Street 1:802 N RIVERSIDE RD
Practice Address - Street 2:STE. 130
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2502
Practice Address - Country:US
Practice Address - Phone:816-271-7673
Practice Address - Fax:816-271-4924
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012008695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1528333184Medicaid
KS200862550AMedicaid
MO701000128Medicare PIN
MO1528333184Medicaid