Tracy A Proctor, CRNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Youngwood, PA
NPI 1306489174 · NPPES record last updated Oct 23, 2019
Key facts
- NPI
- 1306489174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- SP020961 (PA)
- Practice address
- 1050 Depot St
Youngwood, PA 15697-1360 - Phone
- (724) 635-0591
- NPI assigned
- Oct 23, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Stacey Renee Tesauro Inc.
Ember and Bloom Health and Wellness LLC
Practice addresses (Care Compare)
50 W Main St
Suite 704
Uniontown, PA 15401-3311
Phone (724) 439-9698
655 Cherry Tree LN
Uniontown, PA 15401-8947
Phone (724) 415-9169
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- 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 |
|---|---|---|---|---|
| I20220404000113 | PA | Practitioner - Nurse Practitioner | 7719373679 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stacey Renee Tesauro Inc. | Current |
Accepting new patients | |
| Ember & Bloom Health and Wellness LLC | Current |
Accepting new patients |
Locations
50 W Main St
Ste 704
Uniontown, PA 15401
Phone (724) 439-9698
655 Cherry Tree Ln
Uniontown, PA 15401
Phone (724) 415-9169
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | SP020961 | PA | Yes |
Addresses
Primary practice location
1050 Depot St
Youngwood, PA 15697-1360
Mailing address
1050 Depot St
Youngwood, PA 15697-1360
Phone (724) 635-0591
Other providers in Youngwood, PA
- Steven E. Mills
- David Mondock
- Alex Daniel Morgan
- Buffy Lynn Myers
- Heather Pavlinsky
- Jessica Marie Reckner
- Chelsea Lynn Sackett
- Erin Elizabeth Splendore
- Tom & Jerry'S Home Medical Service
- Tri-County Occupantional Medicine PC
All providers in Youngwood, PA · Psychiatric/Mental Health Nurse Practitioner in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 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.