MEDICARE: LACY COKER KESSLER, MD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	P2879	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003177726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LACY COKER KESSLER, MD, PA

Provider Business Mailing Address
First Line	:	2420 WYCON DR
Second Line	:	SUITE 403
City	:	WACO
State	:	TX
Zip	:	76712-8987
Country	:	US
Telephone Number	:	254-420-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 WYCON DR STE 403
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-8988
Country	:	US
Telephone Number	:	254-420-0002
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SARAH J ELLIOTT
Credential	:
Telephone Number	:	254-420-0002

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	01/20/2025

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