Tracey Way Childers
Otolaryngology/Facial Plastic Surgery
1203 E Ross Byp Suite A
Tahlequah
, Oklahoma 74464-4188
Tracey Way Childers
Otolaryngology/Facial Plastic Surgery
1203 E Ross Byp Suite A
Tahlequah
, Oklahoma 74464-4188
(918) 453-9107
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About
Features
Specialties
- Otolaryngology/Facial Plastic Surgery
Languages spoken
- English
Location
First Address
- Tracey Way Childers
- 1203 E Ross Byp Suite A
- Tahlequah, OK
- Zip : 74464-4188
- Fax : (918) 453-9107
- Phone : (918) 453-1234
Second Address
- Tracey Way Childers
- 1203 E Ross Byp Suite A
- Tahlequah, OK
- Zip : 74464-4188
- Fax : (918) 453-9107
- Phone : (918) 453-1234
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 3296 | OK |
National Provider Identifier
| NPI | 1053371021 |
|---|---|
| Provider Name | Tracey Way Childers |
| First Address | Tahlequah, OK 74464-4188 |
| Second Address | Tahlequah, OK 74464-4188 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/03/2006 |
| Last Update Date | 09/03/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 100257460A | (05) | OK |
| 200000030A | (05) | OK |
| DA5295 | RAILROAD MEDICARE GROUP NUMBER (01) | OK |
| G17604 | (02) | OK |
| P00027981 | RAILROAD MEDICARE PIN NUMBER (01) | OK |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.