Basic Information
| Provider Information | |||||||||
| NPI: | 1780094631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARLEY | ||||||||
| FirstName: | LACEY | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 S CUSHMAN AVE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984053631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034282928 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1112 S CUSHMAN AVE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984053631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535932144 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2014 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 201400152RN | OR | N | Nursing Service Providers | Registered Nurse | 363LF0000X | AP61100479 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.