| NPI | 1821453200 |
|---|---|
| Former Name | TRACI BUXTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 291500-4405) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility (Licence: UT 291500-3102) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2022-12-02 |