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General NPI Number Information
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NPI Number | 1003177726
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Entity Type | Organization
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Legal Business Name | LACY COKER KESSLER, MD, PA
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 2420 WYCON DR STE 403
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City | WACO
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State | TX
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Zip | 76712-8988
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Country | US
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Telephone | 254-420-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 WYCON DR SUITE 403
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City | WACO
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State | TX
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Zip | 76712-8987
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Country | US
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Telephone | 254-420-0002
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SARAH J ELLIOTT
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Credential |
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Telephone | 254-420-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | P2879
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License Number State | TX
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