Individual provider Active NPI

Tracy L Tucker, FNP-BC

  • Family Nurse Practitioner
  • Park Hills, MO
National Provider Identifier
1033605514
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2018024153 Issued in MO
Practice address
418 Crane St
Park Hills, MO 63601-1906
Phone
(573) 259-1053
NPI assigned
Jul 7, 2018
Last updated
Oct 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2018024153 MO Primary

Addresses

Primary practice location

418 Crane St
Park Hills, MO 63601-1906

Mailing address

407 Keith St
Park Hills, MO 63601-2007
Phone (573) 259-1053

Other names 1

  • Tracy L Wyrick Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180926000644 MO Practitioner - Nurse Practitioner 3375894660 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.64 of 100Reported as group
Quality
76.13
Improvement activities
40
Cost
69.23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Medical PC CurrentSince Oct 7, 2023 Accepting new patients

Locations

3430 McKelvey Rd
Ste J
Bridgeton, MO 63044
Phone (314) 551-2101

250 Skillman St
Ste 202
Brooklyn, NY 11205

250 Skillman St
Ste 204
Brooklyn, NY 11205
Phone (513) 341-7173

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1530921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1033605514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 KEITH ST",
            "city": "PARK HILLS",
            "state": "MO",
            "postal_code": "636012007",
            "telephone_number": "573-259-1053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 CRANE ST",
            "city": "PARK HILLS",
            "state": "MO",
            "postal_code": "636011906",
            "telephone_number": "573-259-1053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "TRACY",
        "middle_name": "L",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-07",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2018024153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "WYRICK",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Park Hills, MO

Sources for this page

Verify at the official NPI Registry.