Ivy, Tracy Lynn

Ivy, Tracy Lynn is an individual health care provider with primary practice located at 1 Childrens Pl Div Ped Allergy/Immuno/Pulmo, Saint Louis MO 63110-1002. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Sleep Medicine, Allopathic & Osteopathic Physicians / Pediatric Pulmonology. Allopathic & Osteopathic Physicians / Pediatric Pulmonology is her primary health care specialty. Ivy, Tracy Lynn can be contacted via phone (314) 454-2694.

Contact Information

Primary practice address
1 Childrens Pl Div Ped Allergy/Immuno/Pulmo Saint Louis MO 63110-1002
Phone: (314) 454-2694
Fax: (314) 454-2515
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2015008494 Missouri
Allopathic & Osteopathic Physicians / Sleep Medicine 2080S0012X 2015008494 Missouri
Allopathic & Osteopathic Physicians / Pediatric Pulmonology 2080P0214X 2015008494 Missouri

Profile Details

NPI number 1710111331
LBN Legal business name Ivy, Tracy Lynn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2009
Last updated Apr 25th, 2024 - about 8 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 1710111331 NPPES
Missouri MEDICAID 200031877

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