Individual
MRS. MONICA TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-C
Contact information
Practice address
4405 AIRLINE DR, BOSSIER CITY, LA 71111-2058
(318) 470-2101
Mailing address
3931 LE BROOKE LN, BENTON, LA 71006-9726
(318) 470-2101
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP08324
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP08324
LOUISIANA STATE BOARD OF NURSING LICENSE #
LA
Enumeration date
06/18/2015
Last updated
06/18/2015
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