Tracey Renee Puckett, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

30860 Issued in TN

Practice address

1385 S Highland Ave Ste B1
Jackson, TN 38301-7547

Phone

(731) 251-3470

Fax

(731) 201-5250

NPI assigned

Dec 14, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tracey Epperson Puckett Professional name

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vitality Mental Health and Wellness PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Henderson, TN
  • NPI 1093566226
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1588323851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 DRY CREEK RD",
            "city": "PINSON",
            "state": "TN",
            "postal_code": "383661735",
            "telephone_number": "731-251-3470",
            "fax_number": "731-201-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1385 S HIGHLAND AVE STE B1",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383017547",
            "telephone_number": "731-251-3470",
            "fax_number": "731-201-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "TRACEY",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-14",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "30860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "PUCKETT",
            "middle_name": "EPPERSON",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brittany Ann Proudfit, FNP-C
• Psychological Services
• Kelly D Pucek, MD
• Sarah Y Pucek, CRNA
• Delaney Puckett, DO
• Jennifer Neicole Puente, NP
• Elisabeth Jane Pueschel, P.A.
• Jordan Kristian Pueschel, MD
• Ashley Nicole Pugh, PHARMD
• Lesley Anne Pulliam, RN

• Psychiatric/Mental Health Nurse Practitioner in Jackson, TN
• Providers in Jackson, TN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; 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.

Verify at the official NPI Registry.