Provider Demographics
NPI:1508439969
Name:COATS, LACY RAYE
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:RAYE
Last Name:COATS
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 1:4301 NW 156TH PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2175
Mailing Address - Country:US
Mailing Address - Phone:405-479-5993
Mailing Address - Fax:
Practice Address - Street 1:4301 NW 156TH PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2175
Practice Address - Country:US
Practice Address - Phone:405-479-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist