Provider Demographics
NPI:1063480176
Name:WALKER, TRACIE A (MD)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:A
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2796 N HIGHLAND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1846
Mailing Address - Country:US
Mailing Address - Phone:731-616-6881
Mailing Address - Fax:731-736-1909
Practice Address - Street 1:11 WYNDCHASE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7529
Practice Address - Country:US
Practice Address - Phone:731-616-6881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38749362Medicare PIN
TN38749361Medicare PIN
H68225Medicare UPIN