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General NPI Number Information
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NPI Number | 1255996104
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Entity Type | Individual
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Provider Name | AMANDA RENE LACY FNP
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Gender | Female
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 1219 EASTWOOD DR
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City | SEGUIN
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State | TX
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Zip | 78155-5133
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Country | US
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Telephone | 830-379-7777
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Fax | 713-730-3692
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Provider Business Mailing Address
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Address Line | 1908 N LAURENT ST STE 250
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City | VICTORIA
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State | TX
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Zip | 77901-5417
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Country | US
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Telephone | 361-576-0694
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Fax | 713-730-3692
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 756225
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License Number State | TX
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