Basic Information
| Provider Information | |||||||||
| NPI: | 1841752409 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LACY | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 354 HURFFVILLE CROSSKEYS RD BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080803552 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7900 LEES SUMMIT RD | ||||||||
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| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641391236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164044862 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2019 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA11620100 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.