TRACEY DIANNE ECKLUND (NPI# 1811400666) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811400666 |
| Entity Type | Individual |
| Full Name | TRACEY DIANNE ECKLUND |
| Practice Address |
2620 Russel Long Blvd Canyon TX 79016-0001 |
| Mailing Address |
12655 Raymond Rd Amarillo TX 79119-7525 |
| Practice Telephone | 8066513640 |
| Mailing Telephone | 8145124755 |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2017-11-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
2620 RUSSEL LONG BLVD |
| City | CANYON |
| State | TX |
| Zip Code | 79016-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912410762 | Heather Ann Ferrell | Specialist/Technologist | 2620 Russel Long Blvd, Canyon, TX 79016-0001 | 2017-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912920844 | Candy C Marshall | Nurse Practitioner | 2620 Russell Long Blvd, Canyon, TX 79016 | 2006-07-25 |
| 1689014326 | Lorna Strong | Specialist/Technologist | 2342 Russell Long Blvd, Virgil Henson Activities Center 217, Canyon, TX 79016-0001 | 2013-06-26 |
| 1235387184 | Traci B Fredman | Speech-Language Pathologist | 2501 4th Ave, Canyon, TX 79016-0001 | 2008-09-04 |
| 1790971224 | Sally Lynn Gaines | Student in an Organized Health Care Education/Training Program | West Texas A & M University, Old Main, Room 308-a, Canyon, TX 79016-0001 | 2007-09-19 |
| 1639394984 | Robby Douglas Rhodes | Specialist/Technologist | 60216 Wtamu, Canyon, TX 79016-0001 | 2007-04-13 |
| 1992869929 | James Edward Gibbs | Family Medicine | Student Medical Services, 2620 Russell Long Blvd., Canyon, TX 79016-0001 | 2006-12-21 |
| 1407967599 | West Texas A&m University Student Medical Services | Clinic/Center | 2620 N Russel Long Blvd, Virgil Henson Activities Center Room 104, Canyon, TX 79016-0001 | 2006-08-31 |
| 1245341692 | Wendy L Bertram | Nurse Practitioner | 2620 N. Russell Long Blvd, Canyon, TX 79016-0001 | 2006-08-31 |
| 1376526129 | Karen Elizabeth Knapp | Nurse Practitioner | Wt Box 61401, Canyon, TX 79016-0001 | 2005-11-25 |
| 1821469487 | Noel Francis Clifton | Speech-Language Pathologist | 2501 4th Ave, Canyon, TX 79016-0001 | 2015-10-08 |
| Find all providers in zip 79016 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790971224 | Sally Lynn Gaines | Student in an Organized Health Care Education/Training Program | West Texas A & M University, Old Main, Room 308-a, Canyon, TX 79016-0001 | 2007-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720688930 | Kourtney Tapnio | Student in an Organized Health Care Education/Training Program | 8215 Summer Breeze Ln, Rosenberg, TX 77469-1846 | 2020-10-27 |
| 1932708666 | Candice Carriere | Student in an Organized Health Care Education/Training Program | 211 Terrace Creek Ct, Richmond, TX 77406-3590 | 2020-10-23 |
| 1922607373 | Benjamin Allen Barrett | Student in an Organized Health Care Education/Training Program | 12244 Langley Hill Dr, Fort Worth, TX 76244-5544 | 2020-10-17 |
| 1538766597 | Billy Derek Huddleston | Student in an Organized Health Care Education/Training Program | 4661 Cool Ridge Ct, Fort Worth, TX 76133-3831 | 2020-10-02 |
| 1669089157 | Jacob Dainel Frost | Student in an Organized Health Care Education/Training Program | 1207 N Saint James Rd, Pilot Point, TX 76258-2715 | 2020-09-28 |
| 1821605569 | Madison Bettis | Student in an Organized Health Care Education/Training Program | 16609 Green Maze Ln, Helotes, TX 78023-3441 | 2020-09-27 |
| 1659987899 | Chinwe Nwakaego Dike | Student in an Organized Health Care Education/Training Program | 8023 Bueller Pass Ln, Richmond, TX 77407-1824 | 2020-09-22 |
| 1760098271 | Danielle Mortimer | Student in an Organized Health Care Education/Training Program | 1340 Prudential Dr Ste A, Dallas, TX 75235-4115 | 2020-09-20 |
| 1467067462 | Sami Al-aya | Student in an Organized Health Care Education/Training Program | 7114 Lyons Rd, Garland, TX 75043-6633 | 2020-09-15 |
| 1912512005 | Courtney Yates | Student in an Organized Health Care Education/Training Program | 2920 Northlake Cv, Tyler, TX 75703-7033 | 2020-09-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.