Basic Information
Provider Information
NPI: 1184689275
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: TRACI
MiddleName: LYNN
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 E JEFFERSON ST
Address2: KAISER PERMANENTE MEDICARE ENROLLMENT
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018162424
FaxNumber:  
Practice Location
Address1: 201 N WASHINGTON ST
Address2: KAISER PERMANENTE FALLS CHURCH MEDICAL CENTER
City: FALLS CHURCH
State: VA
PostalCode: 220464518
CountryCode: US
TelephoneNumber: 7032374000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/20/2006
LastUpdateDate: 12/06/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X0102201816VAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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