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General NPI Number Information
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NPI Number | 1740046077
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Entity Type | Individual
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Provider Name | LACEY ANN HACKWORTH-ROTHWELL FNP
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Gender | Female
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Dates
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Enumeration Date | 02/23/2024
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 6815 HILL CT
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City | AZLE
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State | TX
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Zip | 76020-5513
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Country | US
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Telephone | 903-650-8939
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Fax |
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Provider Business Mailing Address
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Address Line | 418 SUNFLOWER DR
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City | RAYMORE
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State | MO
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Zip | 64083-7813
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Country | US
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Telephone | 903-276-5017
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1187990
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2024007853
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 53-82956
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License Number State | KS
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