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NPI Code Detail

MEDICARE: LACEY NOLEN KLECKNER CPNP-PC

MEDICARE: LACEY NOLEN KLECKNER CPNP-PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse PractitionerAP135868TX
2363LP0200XPediatric Nurse PractitionerAP135868TX

General Provider Information

NPI Number : 1538673033
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACEY NOLEN KLECKNER CPNP-PC
Provider Business Mailing Address
First Line : 6651 MAIN ST STE E1920
Second Line :
City : HOUSTON
State : TX
Zip : 77030-2428
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6651 MAIN ST STE E1920
Second Line :
City : HOUSTON
State : TX
Zip : 77030-2428
Country : US
Telephone Number : 832-826-5967
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2017
Last Update Date : 01/06/2020

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