Maynor, Tracey Gregory

Maynor, Tracey Gregory is an individual health care provider with primary practice located at 4003 Kresge Way #221, Louisville KY 40207-4652. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Maynor, Tracey Gregory can be contacted via phone (502) 897-7107.

Contact Information

Primary practice address
4003 Kresge Way #221 Louisville KY 40207-4652
Phone: (502) 897-7107
Fax: (502) 897-7613
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA 549 Kentucky

Profile Details

NPI number 1043219520
LBN Legal business name Maynor, Tracey Gregory
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2005
Last updated Jul 8th, 2007 - about 17 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 1043219520 NPPES
Kentucky MEDICAID 9500175600

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