Provider Demographics
NPI:1972751790
Name:RYCHTERA, TRACY L (PA-C)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:RYCHTERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SOLANO ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-3511
Mailing Address - Country:US
Mailing Address - Phone:530-824-4663
Mailing Address - Fax:530-824-5204
Practice Address - Street 1:155 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3511
Practice Address - Country:US
Practice Address - Phone:530-824-4663
Practice Address - Fax:530-824-5204
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19885363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant