Provider Demographics
NPI:1750961413
Name:PATTON, LACI D (APRN)
Entity type:Individual
Prefix:
First Name:LACI
Middle Name:D
Last Name:PATTON
Suffix:
Gender:F
Credentials:APRN
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 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-525-4555
Mailing Address - Fax:
Practice Address - Street 1:1 MERCY LN STE 200A
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6457
Practice Address - Country:US
Practice Address - Phone:501-525-4555
Practice Address - Fax:501-525-4685
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR215051363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner