Provider Demographics
NPI:1104627652
Name:HOWARD, LACEY RACHELLE (LPN)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:RACHELLE
Last Name:HOWARD
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 LEON COMBS DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-2301
Mailing Address - Country:US
Mailing Address - Phone:405-214-5101
Mailing Address - Fax:
Practice Address - Street 1:1938 LEON COMBS DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-2301
Practice Address - Country:US
Practice Address - Phone:405-214-5101
Practice Address - Fax:405-878-5846
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK219044164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse