Provider Demographics
NPI:1841628443
Name:GONZALEZ, LACY NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:NICOLE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:NICOLE
Other - Last Name:BABEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:17756 KATY FWY STE G1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1380
Mailing Address - Country:US
Mailing Address - Phone:832-772-3330
Mailing Address - Fax:832-772-3332
Practice Address - Street 1:17756 KATY FWY STE G1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1380
Practice Address - Country:US
Practice Address - Phone:832-772-3330
Practice Address - Fax:832-772-3332
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09848207N00000X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology