Tracy Sherice Charboneau, REGISTERED NURSE

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R35885 Issued in ND

Practice address

816 3Rd Ave N
Fort Totten, ND 58335-9998

Phone

(701) 766-4285

Fax

(701) 766-1229

NPI assigned

Sep 8, 2021

Last updated

Sep 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: ftc@ftc.directihs.net

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1013686682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88",
            "city": "FORT TOTTEN",
            "state": "ND",
            "postal_code": "583350088",
            "telephone_number": "701-766-4285",
            "fax_number": "701-766-1229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "816 3RD AVE N",
            "city": "FORT TOTTEN",
            "state": "ND",
            "postal_code": "583359998",
            "telephone_number": "701-766-4285",
            "fax_number": "701-766-1229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARBONEAU",
        "first_name": "TRACY",
        "middle_name": "SHERICE",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-08",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ND",
            "license": "R35885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ftc@ftc.directihs.net",
            "affiliation": "N",
            "address_1": "816 3rd Ave N",
            "city": "Fort Totten",
            "state": "ND",
            "country_code": "US",
            "postal_code": "583359998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mikkel Elizabeth Buckmier, NP
• Colette Byrum, BSRT(R)(M)
• Carla Carmona
• Justin Cavanaugh
• Sarah Ruth Cavanaugh
• Lakeisha Chaske
• Erica Lee Clemens, RN
• Kenda Cohen, LCSW
• Angela I Cross, LPN
• Nancy C Dauphinais, MLT

• Registered Nurse in Fort Totten, ND
• Providers in Fort Totten, ND by specialty
• Registered Nurse in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.