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Individual
TRACEY FREDERICK
Active
Individual
TRACEY FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3013585
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001318458
ANTHEM PROVIDER ID NUMBER
—
01
—
2061379
WELLCARE OF KY PROVIDER ID NUMBER
KY
05
—
300030681
—
IN
05
—
7100625390
—
KY
01
—
7247386
UNITED HEALTHCARE PROVIDER ID NUMBER
—
01
—
CS2003600170
CARESOURCE PROVIDER ID NUMBER
—
01
—
PDZ000000382486
AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
KY
Enumeration date
09/18/2019
Last updated
06/09/2022
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