Tracy C Poole, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

123708 Issued in AR

Practice address

1308 E Page Ave
Malvern, AR 72104-4518

Phone

(501) 337-9820

Fax

(501) 468-0478

NPI assigned

Feb 3, 2020

Last updated

Dec 27, 2024By the provider in NPPES

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 names 1

• Tracy C. Bradshaw Other name

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Access Medical Clinic Arkansas LTC LLCGroup PAC ID 0547618175, 141 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Access Medical Clinic Arkansas LTC LLC

  • Rural Health Clinic/Center
  • Weiner, AR
  • NPI 1114578929
  Medicare reassignment Care Compare group NPD
• Curana Health of Arkansas LLC

  • Nurse Practitioner
  • Bentonville, AR
  • NPI 1659750214
  Medicare reassignment NPD
• Daiya Healthcare PLLC

  • Internal Medicine Physician
  • Bellevue, WA
  • NPI 1477027381

  AR

  Medicare reassignment NPD
• Access Medical Clinic Arkansas LTC LLC

  • Rural Health Clinic/Center
  • Lonoke, AR
  • NPI 1265065064
  NPD
• Access Medical Clinic Arkansas LTC LLC

  • Family Medicine Physician
  • Springfield, MO
  • NPI 1841154846
  NPD
• Icarepro of Texas, PA

  • Clinical Nurse Specialist
  • Texarkana, TX
  • NPI 1396193066
  NPD (past)

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

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1912538463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 E PAGE AVE",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721044518",
            "telephone_number": "501-337-9820",
            "fax_number": "501-468-0478"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 N Center St",
            "address_purpose": "LOCATION",
            "city": "Lonoke",
            "state": "AR",
            "postal_code": "720862005",
            "country_code": "US",
            "telephone_number": "501-438-8075",
            "fax_number": "501-468-0452",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1016 N Fourche Ave",
            "address_purpose": "LOCATION",
            "city": "Perryville",
            "state": "AR",
            "postal_code": "721268545",
            "country_code": "US",
            "telephone_number": "501-237-1284",
            "fax_number": "501-468-0469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POOLE",
        "first_name": "TRACY",
        "middle_name": "C",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-03",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AR",
            "license": "123708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "BRADSHAW",
            "middle_name": "C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Marilyn Phelan, CCC A
• Neil Phelan
• Derek Phillips, CMP
• Ashley Plyler
• James Mitchell Plyler
• Shannon Porchia, SHIFT SUPVSR/MHPP
• Chris Porter, RECOVERY ASSISTANT
• Amber Elizabeth Prescott, PHARM.D.
• Presidential Emergency Physicians, LLC
• Misti L. Prewett, L.A.C.

• Gerontology Nurse Practitioner in Malvern, AR
• Providers in Malvern, AR by specialty
• Gerontology Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.