Provider Demographics
NPI:1003578170
Name:ENNEKING, LACY (NP)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:ENNEKING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W EADS PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1374
Mailing Address - Country:US
Mailing Address - Phone:812-539-2900
Mailing Address - Fax:
Practice Address - Street 1:124 CROSS COUNTY PLZ
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-8833
Practice Address - Country:US
Practice Address - Phone:812-539-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030198363LF0000X
IN71012830A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily