Tracy M Lange, MSN, FNP, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Stuart, VA
NPI 1053636613 · NPPES record last updated Nov 5, 2019
Key facts
- NPI
- 1053636613
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 0024168745 (VA)
- Practice address
- 22280 Jeb Stuart Hwy
Stuart, VA 24171-2999 - Phone
- (276) 694-4361
- NPI assigned
- Apr 7, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Piedmont Regional Community Services Board
Practice addresses (Care Compare)
24 Clay St
Martinsville, VA 24112-2810
Phone 27663271281339
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100628000532 | VA | Practitioner - Nurse Practitioner | 5395876809 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024168745 | VA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Piedmont Regional Community Services Board | Current |
Accepting new patients |
Locations
24 Clay St
Martinsville, VA 24112
Phone (276) 632-7128
22280 Jeb Stuart Hwy
Stuart, VA 24171
Phone (276) 632-7128
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 0024168745 | VA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 0024168745 | VA | Yes |
Addresses
Primary practice location
22280 Jeb Stuart Hwy
Stuart, VA 24171-2999
Mailing address
22280 Jeb Stuart Hwy
Stuart, VA 24171-2999
Phone (276) 694-4361
Other practice location 1
324 T B Stanley Hwy
Bassett, VA 24055-6108
Phone (276) 629-1076 ext. 326
Other providers in Stuart, VA
- Kam'S Corner, LLC
- Noel P Kornett
- Ralph Lewis Kramer
- Landmark Alf Operations LLC
- Landmark Transport LLC
- James A. Law
- Legacy Wellness LLC
- David Owen Lewis
- Lexington Clinic Corp
- Lexington Family Physicians LLC
All providers in Stuart, VA · Psychiatric/Mental Health Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.