Individual
LACEY TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
342 E WINDY WAY, PAYSON, AZ 85541-2174
(928) 951-6410
Mailing address
342 E WINDY WAY, PAYSON, AZ 85541-2174
(928) 951-6410
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
LM226
AZ
Other
Enumeration date
12/09/2019
Last updated
12/09/2019
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