Healthcare Provider Details

I. General information

NPI: 1861328734
Provider Name (Legal Business Name): LACEY CLAIRE GEORGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 E ARAPAHOE RD STE 380
CENTENNIAL CO
80112-4045
US

IV. Provider business mailing address

3865 ORCHARD DR
COLORADO SPRINGS CO
80920-7353
US

V. Phone/Fax

Practice location:
  • Phone: 303-226-6180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009921
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: