Individual
KEVIN SCOTT TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2501
Mailing address
PO BOX 600, TUBA CITY, AZ 86045-0600
(928) 283-2501
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
135534
MO
Other
Enumeration date
10/20/2009
Last updated
10/20/2009
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