Provider Demographics
NPI:1619373404
Name:FARRIS, LUCY MICHELLE
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:MICHELLE
Last Name:FARRIS
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 1:650 S ZEDIKER AVE
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-2666
Mailing Address - Country:US
Mailing Address - Phone:559-646-6618
Mailing Address - Fax:559-646-6906
Practice Address - Street 1:650 S ZEDIKER AVE
Practice Address - Street 2:BUILDING 3
Practice Address - City:PARLIER
Practice Address - State:CA
Practice Address - Zip Code:93648-2666
Practice Address - Country:US
Practice Address - Phone:559-646-6618
Practice Address - Fax:559-646-6906
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001408363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health