Provider Demographics
NPI:1871557272
Name:SWEAT, TRACY L (PA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:SWEAT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2839
Mailing Address - Country:US
Mailing Address - Phone:620-504-6241
Mailing Address - Fax:620-504-6341
Practice Address - Street 1:823 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2839
Practice Address - Country:US
Practice Address - Phone:620-504-6241
Practice Address - Fax:620-504-6341
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00534363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN
KS042032Medicare ID - Type UnspecifiedMEDICARE INDIV NUMBER