Provider Demographics
NPI:1275148967
Name:ESTES, LACY DIANE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:DIANE
Last Name:ESTES
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MS
Mailing Address - Zip Code:38827-7737
Mailing Address - Country:US
Mailing Address - Phone:662-454-4520
Mailing Address - Fax:662-452-4521
Practice Address - Street 1:26 3RD ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MS
Practice Address - Zip Code:38827-7737
Practice Address - Country:US
Practice Address - Phone:662-454-4520
Practice Address - Fax:662-454-4521
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily