Provider Demographics
NPI:1194558767
Name:MYERS, LACEY CHRISTINE (NP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:CHRISTINE
Last Name:MYERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:C
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11918 W 600 N
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-8018
Mailing Address - Country:US
Mailing Address - Phone:219-869-4087
Mailing Address - Fax:
Practice Address - Street 1:420 N 26TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2848
Practice Address - Country:US
Practice Address - Phone:765-448-7623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015378A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily