1043732266 NPI number — MRS. LACEY MICHELLE MORRIS FNP-C

Table of content: MRS. LACEY MICHELLE MORRIS FNP-C (NPI 1043732266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043732266 NPI number — MRS. LACEY MICHELLE MORRIS FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS
Provider First Name:
LACEY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KING
Provider Other First Name:
LACEY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043732266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18738 COUNTY ROAD 2171
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEHOUSE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75791-5835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-262-5765
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 E DAWSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75701-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-593-8441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  AP134367 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 75-2616977-123 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8HB314 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 587469YMAF . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01895900 . This is a "MEDICARE RAIL ROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 375023401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com