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General NPI Number Information
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NPI Number | 1366965287
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Entity Type | Individual
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Provider Name | LACEY KATHLEEN THOMPSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 125 CRESTVIEW PARK DR STE 2
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City | DICKSON
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State | TN
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Zip | 37055-2853
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Country | US
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Telephone | 615-446-1370
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Fax | 615-560-5998
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Provider Business Mailing Address
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Address Line | 127 CRESTVIEW PARK DR STE 209
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City | DICKSON
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State | TN
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Zip | 37055-2856
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Country | US
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Telephone | 615-441-4478
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Fax | 615-446-1359
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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