Provider Demographics
NPI:1922723550
Name:HOLTON, LACEY RAY
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:RAY
Last Name:HOLTON
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 1:262 DEMPSIE AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-7662
Mailing Address - Country:US
Mailing Address - Phone:681-361-9509
Mailing Address - Fax:
Practice Address - Street 1:262 DEMPSIE AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-7662
Practice Address - Country:US
Practice Address - Phone:681-361-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant