Provider Demographics
NPI:1982903902
Name:STEVENS, LACEY NICOLE (NP-C)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:NICOLE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 DAVINCI CT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-7627
Mailing Address - Country:US
Mailing Address - Phone:770-582-3993
Mailing Address - Fax:
Practice Address - Street 1:3720 DAVINCI CT
Practice Address - Street 2:SUITE 400
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-7627
Practice Address - Country:US
Practice Address - Phone:770-582-3993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201841363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health