Individual
STACEY ELIZABETH LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 347-8175
(432) 346-7598
Mailing address
1401 MEDICAL PKWY, BLDG B, STE 205, CEDAR PARK, TX 78613-7763
(512) 528-7401
(512) 528-7402
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
758324
TX
363LA2200X
Adult Health Nurse Practitioner
Primary
AP129484
SC
363LG0600X
Gerontology Nurse Practitioner
AP129484
TX
Other
Enumeration date
11/06/2015
Last updated
05/21/2020
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