Individual
MS. LACY C. KINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
149 WALNUT GROVE CHURCH RD, DAYTON, TN 37321-7925
(423) 775-5512
(423) 775-0155
Mailing address
149 WALNUT GROVE CHURCH RD, DAYTON, TN 37321-7925
(423) 775-5512
(423) 775-0155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1301
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4118477
BCBS OF TENNESSEE
TN
05
—
891012560
—
AL
01
—
P00308205
RAILROAD MEDICARE
TN
Enumeration date
06/27/2006
Last updated
04/10/2013
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