Provider Demographics
NPI:1336598655
Name:LACY, KATRINA (DO)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:LACY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:DEMPSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3601 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85723-0001
Mailing Address - Country:US
Mailing Address - Phone:520-629-4809
Mailing Address - Fax:520-783-4458
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-2102
Practice Address - Country:US
Practice Address - Phone:036-283-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine