Provider Demographics
NPI:1992802045
Name:BENEFIELD, TRACI LYNN (PA)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:LYNN
Last Name:BENEFIELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:WESTERLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 PRINCETON AVE SW
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1349
Mailing Address - Country:US
Mailing Address - Phone:205-780-8980
Mailing Address - Fax:205-785-1554
Practice Address - Street 1:817 PRINCETON AVE SW
Practice Address - Street 2:STE 300
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1349
Practice Address - Country:US
Practice Address - Phone:205-780-8980
Practice Address - Fax:205-785-1554
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT1612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant