Provider Demographics
NPI:1841671906
Name:MCNETT, LACEY (CPNP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:MCNETT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 FAIRVIEW AVE
Mailing Address - Street 2:ST 100
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1929
Mailing Address - Country:US
Mailing Address - Phone:580-765-5569
Mailing Address - Fax:
Practice Address - Street 1:415 FAIRVIEW AVE
Practice Address - Street 2:ST 100
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1929
Practice Address - Country:US
Practice Address - Phone:580-765-5569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0080721363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200595970AMedicaid