Basic Information
| Provider Information | |||||||||
| NPI: | 1922020080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICE | ||||||||
| FirstName: | TRACIE | ||||||||
| MiddleName: | KIM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4121 LITTLE SAVANNAH RD | ||||||||
| Address2: | STE 132 | ||||||||
| City: | CULLOWHEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282273378 | ||||||||
| FaxNumber: | 8282277456 | ||||||||
| Practice Location | |||||||||
| Address1: | 4121 LITTLE SAVANNAH RD | ||||||||
| Address2: | STE 132 | ||||||||
| City: | CULLOWHEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282273378 | ||||||||
| FaxNumber: | 8282277456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 09/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 1014 | NC | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | 5214 | NC | N | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 7001515 | 05 | NC | MEDICAID | 7411909 | 05 | NC | MEDICAID |