Provider Demographics
NPI:1861437980
Name:BAUM, TRACY LEE (NP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LEE
Last Name:BAUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 WARM SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:DUBOIS
Mailing Address - State:WY
Mailing Address - Zip Code:82513-9760
Mailing Address - Country:US
Mailing Address - Phone:307-455-2807
Mailing Address - Fax:
Practice Address - Street 1:1424 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1720
Practice Address - Country:US
Practice Address - Phone:425-789-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000450363L00000X
WY33105.1295363LF0000X
WAAP61479503363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY136115500Medicaid
SD4994284OtherBCBS OF SD
SD237000301Medicaid
WY136115500Medicaid
SD6839020Medicaid