Healthcare Provider Details

I. General information

NPI: 1205117132
Provider Name (Legal Business Name): TRACY MCGOWAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 CRESTHAVEN RD SUITE 150
MEMPHIS TN
38119-0800
US

IV. Provider business mailing address

PO BOX 171181
MEMPHIS TN
38187-1181
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-2872
  • Fax: 901-682-9316
Mailing address:
  • Phone: 901-682-2872
  • Fax: 901-682-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number901682
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number16132
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: