Provider Demographics
NPI:1922058841
Name:CRAFTON, LACY LYNN (PA)
Entity Type:Individual
Prefix:MS
First Name:LACY
Middle Name:LYNN
Last Name:CRAFTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:LYNN
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7950 ORTHO LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-9354
Mailing Address - Country:US
Mailing Address - Phone:317-268-3600
Mailing Address - Fax:317-268-3695
Practice Address - Street 1:7950 ORTHO LN
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-9354
Practice Address - Country:US
Practice Address - Phone:317-268-3600
Practice Address - Fax:317-268-3695
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000502A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP33259Medicare UPIN
IN037170C1Medicare ID - Type Unspecified