Tracy Lynne Russell, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00046873 Issued in WA

Practice address

611 N F St
Ste 201
Aberdeen, WA 98520-2667

Phone

(360) 533-7677

Fax

(360) 533-0470

NPI assigned

Feb 2, 2006

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

Other names 1

• Tracy Lynn Knights Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311033600000",
    "number": "1629040894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N F ST",
            "address_2": "STE 201",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985202667",
            "telephone_number": "360-533-7677",
            "fax_number": "360-533-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 N F ST",
            "address_2": "STE 201",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985202667",
            "telephone_number": "360-533-7677",
            "fax_number": "360-533-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "TRACY",
        "middle_name": "LYNNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2011-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00046873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1123256",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "KNIGHTS",
            "middle_name": "LYNN",
            "credential": "M.D,",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Thomas D Rowley, MD
• Cheryl Terese Rubens
• Rupert Family Dentistry
• Stephen Frank Rupert, D.D.S.
• Stephen Ian Rupert, DDS
• Susan Ruyle, M.D.
• Seunghyun Ryoo, DPT
• Safeway Inc
• Derik L Sandoval, SUDPT
• Briana Sansaver

• Pediatrics Physician in Aberdeen, WA
• Providers in Aberdeen, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; 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.