Healthcare Provider Details

I. General information

NPI: 1952205288
Provider Name (Legal Business Name): TRACY PUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 BALTIMORE ST STE 201
MOBILE AL
36605-4730
US

IV. Provider business mailing address

1256 BALTIMORE ST STE 201
MOBILE AL
36605-4730
US

V. Phone/Fax

Practice location:
  • Phone: 251-873-6192
  • Fax: 251-873-6193
Mailing address:
  • Phone: 251-873-6192
  • Fax: 251-873-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2-050564
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: