Provider Demographics
NPI:1295710895
Name:LUMPKIN, TRACIE DOBYNS (PA)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:DOBYNS
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:Y
Other - Last Name:DOBYNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 639993
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11601 IRON BRIDGE RD STE 117
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1467
Practice Address - Country:US
Practice Address - Phone:804-717-5300
Practice Address - Fax:804-748-7269
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN
VAC06249OtherGROUP PTAN
VAC06249OtherGROUP PTAN