Individual
CARLA Y TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
58 BROOKSHIRE LN, BECKLEY, WV 25801-6765
(301) 252-4900
(304) 252-8470
Mailing address
5818 COUNTY ROAD 6, KITTS HILL, OH 45645-8813
(304) 638-0295
(205) 322-1851
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
50590
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720741
BCBS
WV
05
—
2378154
—
OH
05
—
2605295000
—
WV
05
—
74005778
—
KY
Enumeration date
11/27/2006
Last updated
11/16/2022
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