Active NPI
Traci Lavern Main, RN, DHS
- Long-Term Care Clinical Nurse Specialist
- Corydon, IN
National Provider Identifier
1255903084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long-Term Care Clinical Nurse Specialist
- License
- 28256382A
- Practice address
- 871 Pacer CT
Corydon, IN 47112 - Phone
- (812) 738-0317
- NPI assigned
- Jul 12, 2021
- Last updated
- Jul 12, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Long-Term Care Clinical Nurse Specialist | 364SL0600X | 28256382A | IN | Primary |
Addresses
Primary practice location
871 Pacer CT
Corydon, IN 47112
Mailing address
871 Pacer CT
Corydon, IN 47112
Phone (812) 738-0317
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 |
|---|---|---|---|
| 28256382A | IN | MD | Long-Term Care Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626048000000",
"number": "1255903084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "871 PACER CT",
"city": "CORYDON",
"state": "IN",
"postal_code": "47112",
"telephone_number": "812-738-0317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "871 PACER CT",
"city": "CORYDON",
"state": "IN",
"postal_code": "47112",
"telephone_number": "812-738-0317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAIN",
"first_name": "TRACI",
"middle_name": "LAVERN",
"credential": "RN, DHS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-12",
"last_updated": "2021-07-12",
"certification_date": "2021-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "364SL0600X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Long-Term Care",
"state": "IN",
"license": "28256382A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corydon, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.