MEDICARE: TRACY W RAPP DNP

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	363LF0000X	Family Nurse Practitioner	20344	TN

General Provider Information

NPI Number	:	1720451545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY W RAPP DNP

Provider Business Mailing Address
First Line	:	PO BOX 1000, DEPT 978
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0001
Country	:	US
Telephone Number	:	901-320-6915
Fax Number	:	901-320-6920

Provider Business Practice Location Address
First Line	:	3473 POPLAR AVE STE 103
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-4654
Country	:	US
Telephone Number	:	901-320-6915
Fax Number	:	901-320-6920

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

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	08/17/2020

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