Provider Demographics
NPI:1174618458
Name:HOATSON, TRACI L (APRN)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:HOATSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:CLEMENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1214 W A ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4695
Mailing Address - Country:US
Mailing Address - Phone:308-221-6228
Mailing Address - Fax:308-221-6869
Practice Address - Street 1:1214 W A ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4695
Practice Address - Country:US
Practice Address - Phone:308-221-6228
Practice Address - Fax:308-221-6869
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110464363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070592300Medicaid
NE47070592305Medicaid
NE47070592302Medicaid
NEP01106366OtherRAILROAD MEDICARE
NE47070592306Medicaid
NE47070592313Medicaid
NE47066229001Medicaid
NE47070592301Medicaid
NE47070592306Medicaid
NENA1079024Medicare PIN
NE500028567Medicare PIN
NE098368047Medicare PIN
NEP01106366OtherRAILROAD MEDICARE
P37569Medicare UPIN
NE47070592301Medicaid