Basic Information
| Provider Information | |||||||||
| NPI: | 1033468632 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | LACEY | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1079 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424191079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708270353 | ||||||||
| FaxNumber: | 2708274966 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 THIRD ST | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | HENDERSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708260135 | ||||||||
| FaxNumber: | 2708278798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2012 | ||||||||
| LastUpdateDate: | 03/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3007612 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.