Healthcare Provider Details

I. General information

NPI: 1386163327
Provider Name (Legal Business Name): LACEY ANN DUFFY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LACEY ANN DUFFY RN

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 SW 7TH ST
MOORELAND OK
73852-7602
US

IV. Provider business mailing address

PO BOX 923
MOORELAND OK
73852-0923
US

V. Phone/Fax

Practice location:
  • Phone: 580-994-2180
  • Fax: 580-994-2184
Mailing address:
  • Phone: 580-994-2180
  • Fax: 580-994-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202083
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: