Individual
LACIE GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
507 E 16TH ST STE 1, WELLINGTON, KS 67152-2828
(620) 326-3301
Mailing address
507 E 16TH ST STE 1, WELLINGTON, KS 67152-2828
(620) 326-3301
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
046718
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-33377
KANSAS LICENSE
KS
01
—
1124223649
BCBS OF KANSAS
—
05
—
1124223649
—
KS
01
—
12132729
CAQH
—
01
—
1255500633
NON RHC NPI
—
01
—
1437283991
BCBS GROUP NPI
—
Enumeration date
06/15/2007
Last updated
05/08/2020
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