Healthcare Provider Details

I. General information

NPI: 1568376028
Provider Name (Legal Business Name): LACEY THUL BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5148 S KANSAS AVE
WICHITA KS
67216-3230
US

IV. Provider business mailing address

11210 W CARR CT
WICHITA KS
67209-4246
US

V. Phone/Fax

Practice location:
  • Phone: 316-973-1250
  • Fax: 316-973-1260
Mailing address:
  • Phone: 316-992-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-127693-082
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number13-127693-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: