Tracey Joanne Fender, P.N.P.

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP2858 Issued in AZ

Practice address

167 North Main St.
Tuba City, AZ 86045

Phone

(928) 283-2679

NPI assigned

Sep 18, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Tuba City Regional Health Care Corporation

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1548294424

  TX

  Medicare reassignment NPD
• Tuba City Regional Health Care Corporation

  • Family Medicine Physician
  • Bodaway Gap, AZ
  • NPI 1710519913
  NPD

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368662400000",
    "number": "1275729832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 NORTH MAIN ST.",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "86045",
            "telephone_number": "928-283-2679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 NORTH MAIN ST.",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "86045",
            "telephone_number": "928-283-2679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENDER",
        "first_name": "TRACEY",
        "middle_name": "JOANNE",
        "credential": "P.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-18",
        "last_updated": "2013-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "AP2858",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NH",
            "license": "064991-23",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "RN2271333",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ STATE BOARD OF NURSING",
            "identifier": "AP2858",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "064991-23",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin A Everett, MD
• Joan Catherine Farr, RN
• Steven Donald Farr, BSRT R CT MRI ARRT
• Deborah Ann Farrell, RN
• Johmane Farrell, CNA
• Anne (Abbe) B. Fenner, RN
• Gregory Earl Fergus, RN
• Christina Louise Ferguson, RN
• Tina Ferrero, RNC
• Teresita Nayam-an Fiangkiao, R.N.

• Pediatric Nurse Practitioner in Tuba City, AZ
• Providers in Tuba City, AZ by specialty
• Pediatric Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.