Sara Lacy-Antonelli, APRN, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

117846 Issued in OK

Practice address

900 NW 12TH St
Oklahoma City, OK 73106-6804

Phone

(405) 516-0276

NPI assigned

Apr 20, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Sara Lacy Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Revan Health LLC

  • Family Medicine Physician
  • Warr Acres, OK
  • NPI 1114540689
  NPD (past)

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

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1235759291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 NW 12TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731066804",
            "telephone_number": "405-516-0276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 NW 12TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731066804",
            "telephone_number": "405-516-0276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACY-ANTONELLI",
        "first_name": "SARA",
        "credential": "APRN, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-20",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "117846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "LACY",
            "credential": "APRN, NP-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Bonnie Renee Lachance
• James D Lackey, M.D.
• Krystina Lackey, CRNA
• Riley Lackey
• Tyler Lackey, MD
• Jeremy Jon Lacy
• Jessica Ladabouche, APRN
• Brittany Ladd, MD
• Candace Ladd
• Nathan Ladd, LMSW

• Family Nurse Practitioner in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.