Tracy Elizabeth Blanton, NP
Individual provider Active NPI Nurse Practitioner · La Porte, IN
NPI 1508290289 · NPPES record last updated Aug 29, 2013
Key facts
- NPI
- 1508290289
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 28118993A (IN)
- Practice address
- 1007 Lincolnway
La Porte, IN 46350-3201 - Phone
- (219) 325-5474
- Fax
- (219) 325-5456
- NPI assigned
- Aug 29, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20140213000104 | IN | Practitioner - Nurse Practitioner | 8325277494 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28118993A | IN | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 28118993A | IN | Yes |
Addresses
Primary practice location
1007 Lincolnway
La Porte, IN 46350-3201
Mailing address
1007 Lincolnway
La Porte, IN 46350-3201
Phone (219) 325-5474
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | IN |
Other providers in La Porte, IN
- Heidi Marie Bickel
- Kaitlin Ann Bildhauser
- April Lee Bisaga
- Caroline E Bjonback
- Matthew Blackmon
- Pamela Ann Boardman
- Janice Marie Bohlim
- Dawn L. Bohnert
- Michelle Boren
- Marissa Bottos
All providers in La Porte, IN · Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2013. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.