Provider Demographics
NPI:1982893228
Name:KIMES, LACY ANN
Entity Type:Individual
Prefix:MRS
First Name:LACY
Middle Name:ANN
Last Name:KIMES
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 1:600 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4957
Mailing Address - Country:US
Mailing Address - Phone:402-370-3140
Mailing Address - Fax:402-370-3373
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4957
Practice Address - Country:US
Practice Address - Phone:402-370-3140
Practice Address - Fax:402-370-3373
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator