Ivey, Traci L

Ivey, Traci L is an individual health care provider with primary practice located at 2905 S Walton Blvd Suite 17, Bentonville AR 72712-6730. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine, Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Ivey, Traci L can be contacted via phone (479) 657-6501.

Contact Information

Primary practice address
2905 S Walton Blvd Suite 17 Bentonville AR 72712-6730
Phone: (479) 657-6501
Fax: (479) 657-6375
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine 207QH0002X R4023 Arkansas
Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine 2083P0011X R4023 Arkansas
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X R4023 Arkansas

Profile Details

NPI number 1831157858
LBN Legal business name Ivey, Traci L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 1st, 2006
Last updated Apr 18th, 2024 - about 7 months 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 1831157858 NPPES
Arkansas MEDICAID 117573001

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