Healthcare Provider Details

I. General information

NPI: 1760921696
Provider Name (Legal Business Name): TRACY A SCOTT FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 HWY 309 S
BYHALIA MS
38611-9633
US

IV. Provider business mailing address

131 HIGHWAY 309 SOUTH
BYHALIA MS
38611-9633
US

V. Phone/Fax

Practice location:
  • Phone: 662-838-5565
  • Fax: 662-838-4770
Mailing address:
  • Phone: 662-838-5565
  • Fax: 662-838-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902026
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number902026
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: