Individual
TRACIE M METHENY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
63819
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001706470
MSBCBS GROUP
WV
01
—
002003247
MSBCBS
WV
05
—
0207026000
—
WV
01
—
1072527
BRICKSTREET
WV
01
—
27005299700
BRICKSTREET GROUP
WV
01
—
27005299703
OHIO WORKERS COMP GROUP
WV
05
—
3810011018
—
WV
01
—
DA0096
RR MEDICARE
WV
01
—
P00461235
RR MEDICARE
WV
Enumeration date
11/27/2007
Last updated
04/24/2013
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