Individual
KIMBERLY KAY LACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
445 GIENOW RD, RURAL RETREAT, VA 24368-3210
(276) 686-4007
(276) 686-4581
Mailing address
306 S MAIN ST, RURAL RETREAT, VA 24368-3269
(276) 686-4007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102202349
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043403751
—
VA
Enumeration date
08/26/2007
Last updated
10/15/2024
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