Provider Demographics
NPI:1235411257
Name:MCCAULEY, LACEY MOUSER (MMS, PA)
Entity Type:Individual
Prefix:MS
First Name:LACEY
Middle Name:MOUSER
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:MMS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2131 N LOCUST AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4455
Mailing Address - Country:US
Mailing Address - Phone:931-762-6545
Mailing Address - Fax:931-762-6781
Practice Address - Street 1:2131 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4455
Practice Address - Country:US
Practice Address - Phone:931-762-6545
Practice Address - Fax:931-762-6781
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TNPA0000002301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant