Individual
LACY D. RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
268 E MAPLE ST, SALYERSVILLE, KY 41465-8032
(606) 349-5300
(606) 349-5312
Mailing address
268 E MAPLE ST, SALYERSVILLE, KY 41465-8032
(606) 349-5300
(606) 349-5312
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3012873
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100600540
—
KY
Enumeration date
11/13/2018
Last updated
03/29/2023
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