Provider Demographics
NPI:1992564843
Name:WETHINGTON, LACY LEE (APRN)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:LEE
Last Name:WETHINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2679 JONES CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-8587
Mailing Address - Country:US
Mailing Address - Phone:606-706-1400
Mailing Address - Fax:
Practice Address - Street 1:2679 JONES CHAPEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-8587
Practice Address - Country:US
Practice Address - Phone:606-706-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4017249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily