Individual
MS. LACY JOHNSON CONRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3045 KATE BOND RD, BARTLETT, TN 38133-4004
(901) 641-3000
(901) 373-3804
Mailing address
6077 PRIMACY PKWY STE 140, MEMPHIS, TN 38119-5742
(901) 725-8347
(901) 259-7637
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
3316
TN
363AS0400X
Surgical Physician Assistant
Primary
3316
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1136210
NCCPA
TN
01
—
3316
LICENSE UPDATE
TN
Enumeration date
06/27/2017
Last updated
04/20/2021
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