Provider Demographics
NPI:1508512666
Name:HITCHENS, LACIE M (NP)
Entity Type:Individual
Prefix:
First Name:LACIE
Middle Name:M
Last Name:HITCHENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LACIE
Other - Middle Name:M
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:2808 EAST OUTER DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5207
Practice Address - Country:US
Practice Address - Phone:618-993-3817
Practice Address - Fax:618-993-3908
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024719363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner