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NPI Code Detail

MEDICARE: AMANDA RENE LACY FNP

MEDICARE: AMANDA RENE LACY FNP
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
1363LF0000XFamily Nurse Practitioner756225TX

General Provider Information

NPI Number : 1255996104
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA RENE LACY FNP
Provider Business Mailing Address
First Line : 1908 N LAURENT ST STE 250
Second Line :
City : VICTORIA
State : TX
Zip : 77901-5417
Country : US
Telephone Number : 361-576-0694
Fax Number : 713-730-3692
Provider Business Practice Location Address
First Line : 1219 EASTWOOD DR
Second Line :
City : SEGUIN
State : TX
Zip : 78155-5133
Country : US
Telephone Number : 830-379-7777
Fax Number : 713-730-3692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2019
Last Update Date : 03/09/2026

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