Doctor Name: | TRACY LEIGH LADNER |
NPI Number: | 1003239294 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | C.F.N.P |
License Number: | R850568 |
Business Practice Address: | 15200 Community Rd Gulfport, MS - 395033085 |
Business Phone Number: | 2285757000 |
Business Fax Number: | |
Mailing Address: | 11076 Papa Louis Rd, PICAYUNE |
State: | MS |
Postal Code: | 394668897 |
Phone Number: | 6019064311 |
Fax Number: | |
NPI Enumeration Date: | 01/24/2014 |
NPI Last Update Date: | 02/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R850568 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |