Earl, Tracy Ivan

Earl, Tracy Ivan is an individual health care provider with primary practice located at 36 14Th Ave Ne Suite 103, Hickory NC 28601-2580. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Earl, Tracy Ivan can be contacted via phone (828) 345-6468.

Contact Information

Primary practice address
36 14Th Ave Ne Suite 103 Hickory NC 28601-2580
Phone: (828) 345-6468
Fax: (828) 345-1468
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0010-01786 North Carolina

Profile Details

NPI number 1053310250
LBN Legal business name Earl, Tracy Ivan
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2005
Last updated Jan 21st, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053310250 NPPES
North Carolina Other 154755 NORTH CAROLINA MEDICAL BOARD

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