Tracey Jo Gustaveson, RN

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

License

R091797 Issued in AR

Practice address

14901 Cantrell Rd
Little Rock, AR 72223-4255

Phone

(501) 367-1200

NPI assigned

Dec 13, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

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.

• Easter Seals Arkansas

  • Community/Behavioral Health Agency
  • Little Rock, AR
  • NPI 1639869753
  NPD

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

{
    "created_epoch": "1670889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670889600000",
    "number": "1386355089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14901 CANTRELL RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722234255",
            "telephone_number": "501-367-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14901 CANTRELL RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722234255",
            "telephone_number": "501-367-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAVESON",
        "first_name": "TRACEY",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-13",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "AR",
            "license": "R091797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS STATE BOARD OF NURSING",
            "identifier": "R091797",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Cleburne Gurley, PHARMD
• Alexia Susanne Gurnsey
• Sanchita Guruchandrasekar, MD
• Hemalraj Gurunathan
• Riesa Gusewelle, APN
• Caleb Logan Guthrey, M.D.
• Florence Guthrie
• Jacey Tanner Guthrie, M.D.
• Maribel Gutierrez
• Roman Gutkovich, M.D.

• Community Health Registered Nurse in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Community Health Registered Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.