Provider Demographics
NPI:1700249596
Name:KUSY, LACY MICHELLE (ARNPC)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:MICHELLE
Last Name:KUSY
Suffix:
Gender:F
Credentials:ARNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17567
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7567
Mailing Address - Country:US
Mailing Address - Phone:850-475-3600
Mailing Address - Fax:
Practice Address - Street 1:1717 N E ST STE 422
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6333
Practice Address - Country:US
Practice Address - Phone:850-908-1220
Practice Address - Fax:850-908-1229
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1180980363L00000X
FLARNP 9264855363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017042500Medicaid
FL017042500Medicaid
FLARNP 9264855OtherFLORIDA BOARD OF NURSING