| Doctor Name: | KELLY LEE TRACEY |
| NPI Number: | 1255441143 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | 3595 |
| Business Practice Address: | 40232 Junction Dr Oakhurst, CA - 936448719 |
| Business Phone Number: | 5596586400 |
| Business Fax Number: | 5596586460 |
| Mailing Address: | Po Box 28946, FRESNO |
| State: | CA |
| Postal Code: | 93729 |
| Phone Number: | 5596586420 |
| Fax Number: | 5596586460 |
| NPI Enumeration Date: | 08/30/2006 |
| NPI Last Update Date: | 08/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 3595 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |