Provider Demographics
NPI:1063091346
Name:GOBER, LACEY (CRNP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:GOBER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 HUTCH CT
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-1575
Mailing Address - Country:US
Mailing Address - Phone:615-627-8459
Mailing Address - Fax:
Practice Address - Street 1:1029 W MAIN ST STE M
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3347
Practice Address - Country:US
Practice Address - Phone:615-453-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000237578163W00000X
AL3-001079363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse