1316321748 NPI number — MRS. LACY MCMILLON APRN, FNP-C, ENP-C

Table of content: MRS. LACY MCMILLON APRN, FNP-C, ENP-C (NPI 1316321748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316321748 NPI number — MRS. LACY MCMILLON APRN, FNP-C, ENP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMILLON
Provider First Name:
LACY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C, ENP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316321748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
477 LARIAT TRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANDERA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-576-5677
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 12TH ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANDERA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78003-3463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-455-6253
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2015

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: 363LF0000X , with the licence number:  AP128554 , 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)





Copyright © 2007-2025 www.npivalidator.com