Basic Information
| Provider Information | |||||||||
| NPI: | 1548429293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COMPTON | ||||||||
| FirstName: | TRACY | ||||||||
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| Credential: | RN, CSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 PEAR ORCHARD RD NW | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427019455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707359434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1704 N DIXIE HWY # 913 | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427019449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196730761 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2008 | ||||||||
| LastUpdateDate: | 06/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1092229 | KY | Y | Nursing Service Providers | Registered Nurse | 246ZC0007X | SA165 | KY | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.