Provider Demographics
NPI:1306242326
Name:HOOPER, TRACEY MACHELL (NP-C)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:MACHELL
Last Name:HOOPER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MC EWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101-4590
Mailing Address - Country:US
Mailing Address - Phone:931-228-9040
Mailing Address - Fax:931-228-9041
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:
Practice Address - City:MC EWEN
Practice Address - State:TN
Practice Address - Zip Code:37101-4590
Practice Address - Country:US
Practice Address - Phone:931-228-9040
Practice Address - Fax:931-228-9041
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19386261QP2300X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1700284825Medicaid