Provider Demographics
NPI:1043534142
Name:RAMOS, TRACY RENEE (PA-C, ATC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:RENEE
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E 19TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3385
Mailing Address - Country:US
Mailing Address - Phone:541-316-6575
Mailing Address - Fax:541-210-8913
Practice Address - Street 1:176 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624
Practice Address - Country:US
Practice Address - Phone:360-642-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-10148406246Z00000X
ORPA207993363A00000X
363AM0700X
WAPA60866658363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant