Provider Demographics
NPI:1427613488
Name:LACY, ROBIN MARIE (RN)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARIE
Last Name:LACY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6470
Mailing Address - Country:US
Mailing Address - Phone:405-265-3444
Mailing Address - Fax:
Practice Address - Street 1:1707 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6470
Practice Address - Country:US
Practice Address - Phone:405-265-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57277163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent