Provider Demographics
NPI:1548805260
Name:HUFF, TRACY TERRY (CNM)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:TERRY
Last Name:HUFF
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:TERRY
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:1312 BISHOP ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5406
Practice Address - Country:US
Practice Address - Phone:731-885-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000025378367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife