Healthcare Provider Details

I. General information

NPI: 1053826941
Provider Name (Legal Business Name): LACEY R ESTES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N 12TH ST
GRAND JUNCTION CO
81506-2863
US

IV. Provider business mailing address

PO BOX 529
OLATHE CO
81425-0529
US

V. Phone/Fax

Practice location:
  • Phone: 970-245-9370
  • Fax:
Mailing address:
  • Phone: 970-323-6141
  • Fax: 855-299-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005234
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: