Individual
MRS. TRACEY BLACK RESPESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
740 BRAGAW LANE, CHOCOWINITY, NC 27817
(252) 946-9562
Mailing address
7684 BROAD CREEK RD, WASHINGTON, NC 27889-7796
(252) 940-1502
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
005002930
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005002930
STATE LICENSE NUMBER
NC
Enumeration date
05/09/2007
Last updated
12/14/2020
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