Individual
TRACY LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP-BC
Contact information
Practice address
707 HOLLYBROOK DR, LONGVIEW, TX 75605-2410
(903) 757-6042
Mailing address
707 HOLLYBROOK DR, LONGVIEW, TX 75605-2410
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
AP124269
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
325841004
—
TX
01
—
75-2616977-042
TRICARE
TX
01
—
8401MC
BCBS
TX
01
—
P01813068
RAIL ROAD MEDICARE
TX
Enumeration date
07/22/2013
Last updated
10/20/2025
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