Individual
LACY MARIE CRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
227 FALCON DR # 104, MT STERLING, KY 40353-9792
(859) 497-5160
(859) 497-5166
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(859) 497-5160
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2799
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100771230
—
KY
Enumeration date
11/24/2020
Last updated
06/21/2022
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