NPIMap

Individual provider Active NPI

Tracy Doss Nunnally, NP

  • Family Nurse Practitioner
  • Eaton, CO
National Provider Identifier
1245535897
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN.0992881 Issued in CO
Practice address
100 S Cherry Ave Unit 1
Eaton, CO 80615-8256
Phone
(970) 454-3838
NPI assigned
Jan 12, 2011
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN.0992881 CO Primary
Registered Nurse 163W00000X 185357 CO

Addresses

Primary practice location

100 S Cherry Ave Unit 1
Eaton, CO 80615-8256

Mailing address

6600 W 20TH St Unit 26
Greeley, CO 80634-9685
Phone (970) 330-2039

Other practice location 1

1555 N 17th Ave
Greeley, CO 80631-9117
Phone (970) 304-6420 ext. 2309

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170602001166 CO Practitioner - Nurse Practitioner 1951678556 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 S Cherry Ave
Unit 1
Eaton, CO 80615-8256
Phone (970) 454-3838

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
185357COMDRegistered Nurse
APN.0992881COMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Jul 1, 2017 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Jul 1, 2017 Accepting new patients

Locations

100 S Cherry Ave
Unit 1
Eaton, CO 80615
Phone (970) 454-1265

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

Organizations & group practices 2

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1294790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1245535897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 W 20TH ST UNIT 26",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806349685",
            "telephone_number": "970-330-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S CHERRY AVE UNIT 1",
            "city": "EATON",
            "state": "CO",
            "postal_code": "806158256",
            "telephone_number": "970-454-3838"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1555 N 17th Ave",
            "address_purpose": "LOCATION",
            "city": "Greeley",
            "state": "CO",
            "postal_code": "806319117",
            "country_code": "US",
            "telephone_number": "970-304-6420 x2309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NUNNALLY",
        "first_name": "TRACY",
        "middle_name": "DOSS",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-12",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0992881",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "185357",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eaton, CO

Sources for this page

Verify at the official NPI Registry.