Tracey Michelle Foreman, FNP
Individual provider Active NPI Family Nurse Practitioner · Ecru, MS
NPI 1083386643 · NPPES record last updated May 17, 2023
Key facts
- NPI
- 1083386643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 904964 (MS)
- Practice address
- 5482 Highway 15 N
Ecru, MS 38841-8471 - Phone
- (662) 488-8799
- NPI assigned
- Oct 1, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Friendship Medical Clinic LLC
Practice addresses (Care Compare)
509 State Hwy 15 S
New Albany, MS 38652-4502
Phone (662) 534-4330
5482 Hwy 15 N
Ecru, MS 38841-8471
Phone (662) 488-8799
Hospital & facility affiliations
- Baptist Memorial Hospital Union County
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220906002682 | MS | Practitioner - Nurse Practitioner | 6204210503 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 904964 | MS | MD | Family Nurse Practitioner |
| R879104 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Friendship Medical Clinic, LLC | Current |
Accepting new patients | |
| Strategic Solutions-Panola Medical Center LLC | Current |
Accepting new patients | |
| Strategic Solutions-Panola Medical Center LLC | Current |
Accepting new patients |
Locations
303 Medical Center Dr
Batesville, MS 38606
Phone (662) 563-0155
255 Medical Center Dr
Batesville, MS 38606
Phone (662) 563-2163
5482 Highway 15 N
Ecru, MS 38841
Phone (662) 256-9730
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/DGAACA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R879104 | MS | |
| Family Nurse Practitioner | 363LF0000X | 904964 | MS | Yes |
Addresses
Primary practice location
5482 Highway 15 N
Ecru, MS 38841-8471
Mailing address
5482 Highway 15 N
Ecru, MS 38841-8471
Phone (662) 488-8799
Other practice location 1
101 Cunningham Dr
Ripley, MS 38663-1302
Phone (731) 394-1145
Other providers in Ecru, MS
- Allison Miller Bailey
- Jennifer Chism Bolen
- Church Street Manor Assisted Living, Inc.
- Felicia Daniel
- Sabrina Davidson
- Friendship Medical Clinic, LLC
- Friendship, LLC
- Megan Springer Howell
- David Michael McMillen
- Michael L Atkeison
All providers in Ecru, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.