Tracie Allen, PA-C
Individual provider Active NPI Physician Assistant · Memphis, TN
NPI 1174874861 · NPPES record last updated Jul 18, 2018
Key facts
- NPI
- 1174874861
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2417 (TN)
- Practice address
- 262 Danny Thomas PL
Memphis, TN 38105 - Phone
- (901) 595-3300
- NPI assigned
- Sep 21, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085004390 | IL | MD | Physician Assistant |
| 2417 | TN | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085004390 | IL | |
| Physician Assistant | 363A00000X | 2417 | TN | Yes |
Addresses
Primary practice location
262 Danny Thomas PL
Memphis, TN 38105
Mailing address
262 Danny Thomas PL # Ms 515
Memphis, TN 38105-3678
Phone (901) 595-3300
Other names
- Tracie Koebcke
Other providers in Memphis, TN
- Mary Jane Allen
- Paul Allen
- Quinteena Desha Allen
- Sherry Allen
- Sydnie Rachel Allen
- Wanita L Allen
- Allen'S Medical Massage
- Allenbrooke Nursing and Rehabilitation Center, LLC
- Allenbrooke SNF Operations LLC
- Allergy Asthma Immunology Center, PLLC
All providers in Memphis, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.