MEDICARE: TRACY R WALKER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	6629	NC
2	367500000X	Certified Registered Nurse Anesthetist	12312	TN
3	367500000X	Certified Registered Nurse Anesthetist	112847	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BLUE CROSS	OTHER	TN	4140448

General Provider Information

NPI Number	:	1548209828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY R WALKER CRNA

Provider Business Mailing Address
First Line	:	PO BOX 171306
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38187-1306
Country	:	US
Telephone Number	:	800-809-2106
Fax Number	:	901-726-4827

Provider Business Practice Location Address
First Line	:	1500 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-0601
Country	:	US
Telephone Number	:	901-861-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	10/12/2021

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