Provider Demographics
NPI:1538673033
Name:KLECKNER, LACEY NOLEN (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:NOLEN
Last Name:KLECKNER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:CLAIRE
Other - Last Name:NOLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:6651 MAIN ST STE E1920
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6651 MAIN ST STE E1920
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2428
Practice Address - Country:US
Practice Address - Phone:832-826-5967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135868363LP2300X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care