Healthcare Provider Details

I. General information

NPI: 1346973526
Provider Name (Legal Business Name): LACEY TAYLOR PARKMAN DNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1292
BAGDAD AZ
86321-1292
US

IV. Provider business mailing address

PO BOX 1292
BAGDAD AZ
86321-1292
US

V. Phone/Fax

Practice location:
  • Phone: 928-633-6733
  • Fax: 760-659-5610
Mailing address:
  • Phone: 928-633-6733
  • Fax: 760-659-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN216363
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number285292
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: