Healthcare Provider Details

I. General information

NPI: 1164450060
Provider Name (Legal Business Name): PATRICIA GREGG LACEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9129 E 74TH ST
TULSA OK
74133-5286
US

IV. Provider business mailing address

9129 E 74TH ST
TULSA OK
74133-5286
US

V. Phone/Fax

Practice location:
  • Phone: 918-459-5297
  • Fax:
Mailing address:
  • Phone: 918-459-5297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number0031952
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: