Individual
TRACY E LARUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-7994
(601) 815-1722
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-7994
(601) 815-1722
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R850873
MS
Other
Enumeration date
10/21/2009
Last updated
10/21/2009
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