Active NPI
Tracie Tubbs, PA
- Physician Assistant
- Fayetteville, TN
National Provider Identifier
1568838902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2805
- Practice address
- 2893 Huntsville Hwy
Fayetteville, TN 37334-6681 - Phone
- (931) 297-5028
- NPI assigned
- Aug 20, 2015
- Last updated
- Jul 19, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2805 | TN | Primary |
Addresses
Primary practice location
2893 Huntsville Hwy
Fayetteville, TN 37334-6681
Mailing address
2893 Huntsville Hwy
Fayetteville, TN 37334-6681
Phone (931) 297-5028
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160601000923 | TN | Order and Referring Only - Physician Assistant | 2264401520 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2805 | TN | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468886400000",
"number": "1568838902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2893 HUNTSVILLE HWY",
"city": "FAYETTEVILLE",
"state": "TN",
"postal_code": "373346681",
"telephone_number": "931-297-5028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2893 HUNTSVILLE HWY",
"city": "FAYETTEVILLE",
"state": "TN",
"postal_code": "373346681",
"telephone_number": "931-297-5028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUBBS",
"first_name": "TRACIE",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-20",
"last_updated": "2016-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "2805",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, TN
- Kristy Dawn Tolleson, LMT
- Top Flight Medical Group LLC
- Michael Shane Trahin, DC
- Tri-State Clinic of Chiropractic, PC
- Elizabeth Truesdale, RN, IBCLC
- Sheila Cherie Urbina Worley, APRN
- Vanderbilt University
- Wal-Mart Stores East LP (Wal-Mart Pharmacy10-0314)
- Wal-Mart Stores East, LP (Vision Center 30-0314)
- Walgreen Co (Walgreens #09314)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.