Provider Demographics
NPI:1043732266
Name:MORRIS, LACEY MICHELLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:MICHELLE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:LACEY
Other - Middle Name:MICHELLE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18738 COUNTY ROAD 2171
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-5835
Mailing Address - Country:US
Mailing Address - Phone:903-262-5765
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134367363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-123OtherTRICARE
TX8HB314OtherBCBS
587469YMAFOtherMEDICARE
TXP01895900OtherMEDICARE RAIL ROAD
TX375023401Medicaid