Healthcare Provider Details

I. General information

NPI: 1629227608
Provider Name (Legal Business Name): LACEY PALMER CONAWAY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 CORDOVA CV
GERMANTOWN TN
38138-2200
US

IV. Provider business mailing address

1374 CORDOVA CV
GERMANTOWN TN
38138-2200
US

V. Phone/Fax

Practice location:
  • Phone: 602-816-2938
  • Fax:
Mailing address:
  • Phone: 602-816-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number38207
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number902490
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: