Individual
KACIE DANIELLE TRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834
(252) 752-2140
(252) 689-6502
Mailing address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834-3770
(252) 752-2140
(252) 689-6502
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
259072
NC
367500000X
Certified Registered Nurse Anesthetist
121750
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
5880
NC
Other
Enumeration date
05/04/2018
Last updated
05/13/2021
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