Provider Demographics
NPI:1386163327
Name:DUFFY, LACEY ANN (APRN)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:DUFFY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:ANN
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:SEILING
Mailing Address - State:OK
Mailing Address - Zip Code:73663-0720
Mailing Address - Country:US
Mailing Address - Phone:580-821-6619
Mailing Address - Fax:580-922-7360
Practice Address - Street 1:809 NE HWY 60
Practice Address - Street 2:
Practice Address - City:SEILING
Practice Address - State:OK
Practice Address - Zip Code:73663-0845
Practice Address - Country:US
Practice Address - Phone:580-922-4150
Practice Address - Fax:580-922-7360
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202083363LF0000X, 207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine