Healthcare Provider Details

I. General information

NPI: 1467194928
Provider Name (Legal Business Name): LACEE KEELE ARDMS, RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 S BENTLEY BLVD STE 1
CEDAR CITY UT
84720-1822
US

IV. Provider business mailing address

1156 S BENTLEY BLVD STE 1
CEDAR CITY UT
84720-1822
US

V. Phone/Fax

Practice location:
  • Phone: 435-708-0145
  • Fax:
Mailing address:
  • Phone: 435-708-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: