Tracy Shawn Edwards, APN
Individual provider Active NPI Women's Health Nurse Practitioner · Little Rock Afb, AR
NPI 1497937577 · NPPES record last updated May 17, 2019
Key facts
- NPI
- 1497937577
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Women's Health Nurse Practitioner 363LW0102X
- License
- 2012038001 (MO)
- Practice address
- 1090 Arnold Dr
Little Rock Afb, AR 72099-3309 - Phone
- (501) 987-3080
- NPI assigned
- Nov 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 151223 | MO | MD | Registered Nurse |
| 2012038001 | MO | MD | Women's Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 151223 | MO | |
| Women's Health Nurse Practitioner | 363LW0102X | 2012038001 | MO | Yes |
Addresses
Primary practice location
1090 Arnold Dr
Little Rock Afb, AR 72099-3309
Mailing address
62 Jamestown Dr
Saint Peters, MO 63376-1309
Phone (314) 667-5959
Other providers in Little Rock Afb, AR
- Patrick Depriest
- Mylinda Lou Dill
- Geriann T Dillender
- Alex Dudash
- Matthew Joe Edwards
- Tamara Lilloux Elsen
- Drew Ferguson
- Gena Rochelle Garrett
- Katherine B Gilchrist
- Zachary Preston Gravgaard
All providers in Little Rock Afb, AR · Women's Health Nurse Practitioner in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.