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General NPI Number Information
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NPI Number | 1457027419
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Entity Type | Individual
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Provider Name | LACEY ANN SKELTON LEVEL 1 MED AIDE
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Gender | Female
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 18941 CR 305A
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City | EMINENCE
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State | MO
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Zip | 65466-6268
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Country | US
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Telephone | 573-226-5426
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Fax | 573-226-5426
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Provider Business Mailing Address
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Address Line | 18941 CR 305A
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City | EMINENCE
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State | MO
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Zip | 65466-6268
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Country | US
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Telephone | 573-226-5426
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Fax | 573-226-5426
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 049124
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License Number State | MO
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