Provider Demographics
NPI:1477856722
Name:LACY, FELICIA SHERRELL
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:SHERRELL
Last Name:LACY
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 1:32 CONRAD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2801
Mailing Address - Country:US
Mailing Address - Phone:731-541-4548
Mailing Address - Fax:
Practice Address - Street 1:32 CONRAD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2801
Practice Address - Country:US
Practice Address - Phone:731-541-4548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator