Provider Demographics
NPI:1417236571
Name:JONES, LACEY L (FNP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 VO TECH DR STE 4
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1329
Mailing Address - Country:US
Mailing Address - Phone:931-474-1224
Mailing Address - Fax:931-474-7190
Practice Address - Street 1:1589 SPARTA ST
Practice Address - Street 2:SUITE 307
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1390
Practice Address - Country:US
Practice Address - Phone:931-815-7200
Practice Address - Fax:931-815-7205
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily