Healthcare Provider Details

I. General information

NPI: 1730418427
Provider Name (Legal Business Name): TRACY SCRUGGS-BLANKENSHIP F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W FOREST AVE145 INNOVATION DRSTE 300
JACKSON TN
38305-3019
US

IV. Provider business mailing address

PO BOX 400
JACKSON TN
38302-0400
US

V. Phone/Fax

Practice location:
  • Phone: 731-422-0213
  • Fax: 731-506-1849
Mailing address:
  • Phone: 731-423-8697
  • Fax: 731-423-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14857
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: