Healthcare Provider Details

I. General information

NPI: 1609705599
Provider Name (Legal Business Name): CHERISE YVETTE LACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E WILLOW DR
OLATHE KS
66062-1812
US

IV. Provider business mailing address

3130 BROOKLYN AVE
KANSAS CITY MO
64109-2134
US

V. Phone/Fax

Practice location:
  • Phone: 913-745-7288
  • Fax:
Mailing address:
  • Phone: 913-745-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number240327
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: