Provider Demographics
NPI:1598538563
Name:DUFFETT, LACY MARIE (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:MARIE
Last Name:DUFFETT
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 159TH TER
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-8701
Mailing Address - Country:US
Mailing Address - Phone:816-809-6375
Mailing Address - Fax:
Practice Address - Street 1:1909 159TH TER
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-8701
Practice Address - Country:US
Practice Address - Phone:816-809-6375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSL-310975163WL0100X
KS14-128769-082163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant