Individual
KATHY LYNNE TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
176 LONGVILLE CHURCH RD, LONGVILLE, LA 70652-5036
(337) 794-5745
Mailing address
314 W HALE ST, LAKE CHARLES, LA 70601-8439
(337) 794-5745
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
023904
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1429082
—
LA
Enumeration date
05/24/2006
Last updated
09/29/2015
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