Lacey Gober, CRNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

3-001079 Issued in AL

Practice address

1029 W Main St Ste M
Lebanon, TN 37087-3347

Phone

(615) 453-1252

NPI assigned

Apr 5, 2021

Last updated

Jul 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Houston County Healthcare Authority

  dba Samc-Enterprise Medical Clinic

  • Internal Medicine Physician
  • Enterprise, AL
  • NPI 1619026606
  Medicare reassignment NPD
• Houston County Healthcare Authority

  dba SAMC- Profee Billing

  • Internal Medicine Physician
  • Dothan, AL
  • NPI 1285783134
  NPD
• Houston County Healthcare Authority

  dba Southeast Alabama Medical Center Medical Clinics

  • Internal Medicine Physician
  • Dothan, AL
  • NPI 1538597349
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1063091346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 HUTCH CT",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370661575",
            "telephone_number": "615-627-8459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 W MAIN ST STE M",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370873347",
            "telephone_number": "615-453-1252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOBER",
        "first_name": "LACEY",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-05",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AL",
            "license": "3-001079",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "0000237578",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Giles
• Katrina Marie Gill, PA
• Patricia J Gipson, DPH
• Gity Transport
• Kristie Glover
• Michael Anthony Gonzales Jr.
• Jack Allan Goode
• Mary Goodner, LCSW
• Jennifer Jacobson Goshow, PA-C
• Hannah Gott, RBT

• Pediatric Nurse Practitioner in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Pediatric Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.