Individual
JESSICA LUCILE TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
305 PACIFIC AVE S, KELSO, WA 98626-1638
(360) 795-5008
Mailing address
11 ASHLAND ST, KALAMA, WA 98625-9649
(360) 936-9884
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP61461645
WA
Other
Enumeration date
10/21/2024
Last updated
10/21/2024
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