Provider Demographics
NPI:1215356464
Name:LYLE, LACEY DOOLEY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:DOOLEY
Last Name:LYLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 BURNETTS WAY STE 320
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8288
Mailing Address - Country:US
Mailing Address - Phone:757-934-1900
Mailing Address - Fax:757-925-6719
Practice Address - Street 1:5839 HARBOUR VIEW BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3797
Practice Address - Country:US
Practice Address - Phone:757-967-0676
Practice Address - Fax:757-967-0675
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024171601363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily