=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730901174
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LACY TURLEY COMMUNITY HEALTH WOR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2024
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 1538
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97365-0115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-574-9570
-----------------------------------------------------
Fax | 541-574-8857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1538
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97365-0115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-574-9570
-----------------------------------------------------
Fax | 541-574-8857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number | 112157
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------