| NPI | 1043417132 |
|---|---|
| Former Name | TRACEY LYNN KINCANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704217231) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F309789) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2021-03-19 |