Provider Demographics
NPI:1669521647
Name:LACEY, SKYE D (PA-C)
Entity type:Individual
Prefix:
First Name:SKYE
Middle Name:D
Last Name:LACEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:9300 E 29TH ST N STE 310
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2160
Mailing Address - Country:US
Mailing Address - Phone:316-612-1833
Mailing Address - Fax:316-612-2420
Practice Address - Street 1:9300 E 29TH ST N STE 310
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2160
Practice Address - Country:US
Practice Address - Phone:316-612-1833
Practice Address - Fax:316-612-2420
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2025-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant