MEDICARE: MS. TRACI ROBINSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	8434479	TN

General Provider Information

NPI Number	:	1225462088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACI ROBINSON

Provider Business Mailing Address
First Line	:	1869 HIGHWAY 45 BYP
Second Line	:	SUITE 5
City	:	JACKSON
State	:	TN
Zip	:	38305-2464
Country	:	US
Telephone Number	:	731-660-0880
Fax Number	:	731-668-0380

Provider Business Practice Location Address
First Line	:	1869 HIGHWAY 45 BYP
Second Line	:	SUITE 5
City	:	JACKSON
State	:	TN
Zip	:	38305-2464
Country	:	US
Telephone Number	:	731-660-0880
Fax Number	:	731-668-0380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/29/2013

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