Provider Demographics
NPI:1417669656
Name:ALLEN, LACEY JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:JO
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-7730
Mailing Address - Country:US
Mailing Address - Phone:304-588-5448
Mailing Address - Fax:
Practice Address - Street 1:3 WESTERN HILLS DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-8122
Practice Address - Country:US
Practice Address - Phone:304-494-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV86059163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health