Individual
LACEY MCNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
415 FAIRVIEW AVE, ST 100, PONCA CITY, OK 74601-1929
(580) 765-5569
Mailing address
415 FAIRVIEW AVE, ST 100, PONCA CITY, OK 74601-1929
(580) 765-5569
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R0080721
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200595970A
—
OK
Enumeration date
06/15/2015
Last updated
08/20/2020
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