Healthcare Provider Details

I. General information

NPI: 1538017009
Provider Name (Legal Business Name): MR. TRACY LANGFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POPLAR AVE STE 700
MEMPHIS TN
38157-0700
US

IV. Provider business mailing address

2609 BREEZY RIDGE TRL
CORDOVA TN
38016-6602
US

V. Phone/Fax

Practice location:
  • Phone: 901-276-2662
  • Fax:
Mailing address:
  • Phone: 901-276-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number41538
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: