Provider Demographics
NPI:1588136469
Name:DUCKWORTH, TRACY LYNN (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:DUCKWORTH
Suffix:
Gender:
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6310
Mailing Address - Country:US
Mailing Address - Phone:918-759-2032
Mailing Address - Fax:918-759-2077
Practice Address - Street 1:1200 S BELMONT AVE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6310
Practice Address - Country:US
Practice Address - Phone:918-759-2032
Practice Address - Fax:918-759-2077
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily