Individual
KELLY LEE TRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3124 WILLOW CREEK RD, PRESCOTT, AZ 86301-6610
(923) 445-7085
(928) 433-0730
Mailing address
81 W GUADALUPE RD STE 111, GILBERT, AZ 85233-3321
(480) 366-4490
(480) 854-3618
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
20A11995
CA
208D00000X
General Practice Physician
3595
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
776940
—
AZ
Enumeration date
08/30/2006
Last updated
04/16/2025
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