Individual
TYSON A LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
600 MEDICAL CENTER DR, NEWTON, KS 67114-8780
(316) 804-6213
Mailing address
PO BOX 2897, WICHITA, KS 67201-2897
(800) 374-5326
(800) 374-7656
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1390058032
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
557048
KS
367500000X
Certified Registered Nurse Anesthetist
TMP143428
KS
Other
Enumeration date
07/29/2011
Last updated
01/13/2022
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