Provider Demographics
NPI:1487994208
Name:ARWOOD, TRACEY A (CNM)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:A
Last Name:ARWOOD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 S SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2046
Mailing Address - Country:US
Mailing Address - Phone:417-967-5639
Mailing Address - Fax:417-967-5667
Practice Address - Street 1:1333 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2046
Practice Address - Country:US
Practice Address - Phone:417-967-5639
Practice Address - Fax:417-967-5667
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS146285367A00000X
MO2014014274367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1487994208Medicaid
MO26D2006074OtherMG CLIA
MO26D0889777OtherMOB CLIA
MO268653Medicare Oscar/Certification
MO1487994208Medicaid