Provider Demographics
NPI:1265653521
Name:LAWSON, STACEY M
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:M
Last Name:LAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2728
Mailing Address - Country:US
Mailing Address - Phone:270-753-7966
Mailing Address - Fax:
Practice Address - Street 1:2209 QUAIL CREEK DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2728
Practice Address - Country:US
Practice Address - Phone:270-753-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1185OtherINDEPENDENT PROVIDER