Active NPI
Kevin Scott Tracy, R.N.
- Case Management Registered Nurse
- Tuba City, AZ
National Provider Identifier
1114253572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Management Registered Nurse
- License
- 135534
- Practice address
- 167 North Main Street
Tuba City, AZ 86045-0600 - Phone
- (928) 283-2501
- NPI assigned
- Oct 20, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Registered Nurse | 163WC0400X | 135534 | MO | Primary |
Addresses
Primary practice location
167 North Main Street
Tuba City, AZ 86045-0600
Mailing address
PO Box 600
Tuba City, AZ 86045-0600
Phone (928) 283-2501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 135534 | MO | MD | Case Management Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255996800000",
"number": "1114253572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 600",
"city": "TUBA CITY",
"state": "AZ",
"postal_code": "860450600",
"telephone_number": "928-283-2501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "167 NORTH MAIN STREET",
"city": "TUBA CITY",
"state": "AZ",
"postal_code": "860450600",
"telephone_number": "928-283-2501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACY",
"first_name": "KEVIN",
"middle_name": "SCOTT",
"credential": "R.N.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-20",
"last_updated": "2009-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "163WC0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Case Management",
"state": "MO",
"license": "135534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tuba City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.