MEDICARE: MS. LACY SMITH FNP-BC, PMHNP-BC

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
1	363LF0000X	Family Nurse Practitioner	216289	OK
2	163WM0705X	Medical-Surgical Registered Nurse	13-127040-052	KS
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	216289	OK
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	53-78893	KS
5	363LF0000X	Family Nurse Practitioner	53-78893	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992358378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LACY SMITH FNP-BC, PMHNP-BC

Provider Business Mailing Address
First Line	:	8101 COLLEGE BLVD STE 130
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66210-2793
Country	:	US
Telephone Number	:	620-649-2505
Fax Number	:	669-204-0329

Provider Business Practice Location Address
First Line	:	6203 E OXFORD ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-5522
Country	:	US
Telephone Number	:	620-649-2505
Fax Number	:	669-204-0329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	05/05/2026

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Directions to “ MS. LACY SMITH FNP-BC, PMHNP-BC” Practice Location

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