Provider Demographics
NPI:1760921696
Name:SCOTT, TRACY A (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 HIGHWAY 309 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-9633
Mailing Address - Country:US
Mailing Address - Phone:662-838-5565
Mailing Address - Fax:662-838-4770
Practice Address - Street 1:131 HWY 309 S
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611-9633
Practice Address - Country:US
Practice Address - Phone:662-838-5565
Practice Address - Fax:662-838-4770
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902026363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS005802361Medicaid