Provider Demographics
NPI:1124179148
Name:LACEY, JANET (CRNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:LACEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407, DEPT 5839
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0001
Mailing Address - Country:US
Mailing Address - Phone:256-386-9961
Mailing Address - Fax:256-386-9960
Practice Address - Street 1:1208 S JACKSON HWY
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5749
Practice Address - Country:US
Practice Address - Phone:256-386-9961
Practice Address - Fax:256-386-9960
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL147196Medicaid