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1760907455 NPI number — LACEY MILLER

NPI Number: 1760907455
Health Care Provider/Practitioner: LACEY MILLER

Information about “1760907455” NPI (LACEY MILLER) exists in 1760907455 in HTML format HTML  |  1760907455 in plain Text format TXT  |  1760907455 in PDF (Portable Document Format) PDF  |  1760907455 in an XML format XML  formats.

NPI Number : 1760907455 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760907455",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MILLER",
    "FirstName": "LACEY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "495 GRAND BLVD STE 206",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIRAMAR BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32550-1408",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "470-350-4138",
    "MailingAddressFaxNumber": "321-250-7463",
    "FirstLinePracticeLocationAddress": "495 GRAND BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 206",
    "PracticeLocationAddressCityName": "MIRAMAR BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32550-1408",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "470-350-4138",
    "PracticeLocationAddressFaxNumber": "321-250-7463",
    "EnumerationDate": "08/03/2017",
    "LastUpdateDate": "10/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103K00000X",
        "TaxonomyName": "Behavior Analyst",
        "LicenseNumber": "1-20-42649",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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