Provider Demographics
NPI:1508233156
Name:MCKINLEY, LACY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LACY
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-2000
Mailing Address - Fax:850-416-2080
Practice Address - Street 1:4033 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3506
Practice Address - Country:US
Practice Address - Phone:850-416-2340
Practice Address - Fax:850-416-2345
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9247512363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner