Provider Demographics
NPI:1174929004
Name:UNDERWOOD, TRACY (CFNP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 N PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-7688
Mailing Address - Country:US
Mailing Address - Phone:304-441-2001
Mailing Address - Fax:
Practice Address - Street 1:1343 N PRESTON HWY
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-7688
Practice Address - Country:US
Practice Address - Phone:304-441-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV45465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily