Healthcare Provider Details

I. General information

NPI: 1598234783
Provider Name (Legal Business Name): LACEY MICHELLE JONES ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 OKLAHOMA BLVD
ALVA OK
73717-2753
US

IV. Provider business mailing address

709 UNIVERSITY BLVD
ALVA OK
73717
US

V. Phone/Fax

Practice location:
  • Phone: 580-327-8627
  • Fax:
Mailing address:
  • Phone: 620-295-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number947
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: