Individual provider Active NPI

Tracy Kourajian, NP

  • Women's Health Nurse Practitioner
  • Fenton, MO
National Provider Identifier
1932079407
Registry record updated Nov 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
2025031278 Issued in MO
Practice address
917 Villa Gran Way
Fenton, MO 63026-6311
Phone
(314) 640-2033
NPI assigned
Nov 10, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 2025031278 MO Primary

Addresses

Primary practice location

917 Villa Gran Way
Fenton, MO 63026-6311

Mailing address

917 Villa Gran Way
Fenton, MO 63026-6311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2025031278MOMDWomen's Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1762732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763510400000",
    "number": "1932079407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 VILLA GRAN WAY",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630266311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 VILLA GRAN WAY",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630266311",
            "telephone_number": "314-640-2033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOURAJIAN",
        "first_name": "TRACY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-11-10",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MO",
            "license": "2025031278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; 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.