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Individual

MS. LACY SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FNP-BC, PMHNP-BC

Contact information

Practice address
6203 E OXFORD ST, WICHITA, KS 67220-5522
(620) 649-2505
(669) 204-0329
Mailing address
8101 COLLEGE BLVD STE 130, OVERLAND PARK, KS 66210-2793
(620) 649-2505
(669) 204-0329

Taxonomy

Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
13-127040-052
KS
363LF0000X
Family Nurse Practitioner
216289
OK
363LF0000X
Family Nurse Practitioner
53-78893
KS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
216289
OK
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
53-78893
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201236440A
OK
05
201291660A
KS
Enumeration date
07/24/2019
Last updated
05/05/2026
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