Provider Demographics
NPI:1053690636
Name:YAWN, TRACI K (FNP)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:K
Last Name:YAWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:ANN
Other - Last Name:KURPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, MSN, RN
Mailing Address - Street 1:500 W 3RD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1985
Mailing Address - Country:US
Mailing Address - Phone:229-312-8500
Mailing Address - Fax:229-312-5853
Practice Address - Street 1:425 W 3RD AVE
Practice Address - Street 2:STE 105
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1941
Practice Address - Country:US
Practice Address - Phone:229-312-0707
Practice Address - Fax:229-312-0705
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily