Healthcare Provider Details

I. General information

NPI: 1992358378
Provider Name (Legal Business Name): LACY SMITH FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS LACY MCINTYRE

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CHOUTEAU AVE
SUBLETTE KS
67877-6738
US

IV. Provider business mailing address

8101 COLLEGE BLVD STE 130
OVERLAND PARK KS
66210-2793
US

V. Phone/Fax

Practice location:
  • Phone: 620-649-2505
  • Fax: 669-204-0329
Mailing address:
  • Phone: 620-649-2505
  • Fax: 669-204-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78893
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number216289
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-78893
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number13-127040-052
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216289
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: