Individual
TRACEY SUZANNE DUDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3613 NW 56TH ST STE 150, OKLAHOMA CITY, OK 73112-4506
(405) 600-1210
Mailing address
2911 NW 17TH ST, OKLAHOMA CITY, OK 73107-3901
(405) 226-6513
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
101402
OK
364SP0200X
Pediatric Clinical Nurse Specialist
101402
OK
Other
Enumeration date
03/02/2018
Last updated
02/03/2019
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