Active NPI
Candice Lacey, PTA
- Physical Therapy Assistant
- Berryville, AR
National Provider Identifier
1033935283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 4270
- Practice address
- 806 W College Ave
Berryville, AR 72616-3107 - Phone
- (870) 423-3124
- NPI assigned
- Dec 3, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 4270 | AR | Primary |
Addresses
Primary practice location
806 W College Ave
Berryville, AR 72616-3107
Mailing address
2413 Turner Way
Pea Ridge, AR 72751-2523
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4270 | AR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733184000000",
"number": "1033935283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2413 TURNER WAY",
"city": "PEA RIDGE",
"state": "AR",
"postal_code": "727512523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "806 W COLLEGE AVE",
"city": "BERRYVILLE",
"state": "AR",
"postal_code": "726163107",
"telephone_number": "870-423-3124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACEY",
"first_name": "CANDICE",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-12-03",
"last_updated": "2024-12-03",
"certification_date": "2024-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "AR",
"license": "4270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berryville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.