Tracie Lane Gilliland, MSN, APRN, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Flippin, AR
NPI 1568082006 · NPPES record last updated Apr 24, 2020
Key facts
- NPI
- 1568082006
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 124431 (AR)
- Practice address
- 360 MC 7097
Flippin, AR 72634-8419 - Phone
- (870) 404-2347
- NPI assigned
- Apr 24, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
104 Dyer St
Mountain Home, AR 72653-3514
Phone (870) 232-0397
Hospital & facility affiliations
- Baxter Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- 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 |
|---|---|---|---|---|
| I20200818000027 | AR | Practitioner - Nurse Practitioner | 0547686826 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 124431 | AR | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baxter County Regional Hospital, Inc. | Current |
Accepting new patients | |
| Advanced Medicine of the Ozarks, LTD | Family | Current |
Accepting new patients |
| Baxter County Regional Hospital, Inc | Current |
Accepting new patients | |
| Ozarks Medical Center | Past | Accepting new patients |
Locations
555 W 6th St
Mountain Home, AR 72653
Phone (870) 425-1787
1790 Highway 5 N
Unit 3
Mountain Home, AR 72653
Phone (870) 232-0397
104 Dyer St
Mountain Home, AR 72653
Phone (870) 232-0397
624 Hospital Dr
#6S
Mountain Home, AR 72653
Phone (870) 421-6023
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 124431 | AR | Yes |
Addresses
Primary practice location
360 MC 7097
Flippin, AR 72634-8419
Mailing address
360 MC 7097
Flippin, AR 72634-8419
Phone (870) 404-2347
Other providers in Flippin, AR
- FPNC, Inc.
- David Glenn Fulghum
- Full Circle Recovery Incorporated
- Hannah Gallegos
- Lisa M Gardner
- GMT and P Enterprises
- Kim Harrison
- Sylvia Irene Hathaway
- Julie M King
- Johnny Mitchell
All providers in Flippin, AR · Family 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 Apr 24, 2020. 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.