Provider Demographics
NPI:1871804278
Name:LEMLEY, TRACY DORINDA
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DORINDA
Last Name:LEMLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:DORINDA
Other - Last Name:WITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:305 EAST AVE H
Mailing Address - Street 2:
Mailing Address - City:NOLANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76559
Mailing Address - Country:US
Mailing Address - Phone:254-698-6255
Mailing Address - Fax:
Practice Address - Street 1:305 E AVE H
Practice Address - Street 2:
Practice Address - City:NOLANVILLE
Practice Address - State:TX
Practice Address - Zip Code:76559-4104
Practice Address - Country:US
Practice Address - Phone:254-698-6255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124697164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse