Lacy Kennedy Eaton, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA07377 Issued in TX

Practice address

3564 N Fourth St Ste a
Longview, TX 75605-0039

Phone

(903) 230-3311

Fax

(903) 230-3312

NPI assigned

Oct 3, 2011

Last updated

Nov 17, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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 TX

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

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• FHIR API: https://fhir4.healow.com/fhir/r4/BEDJDD

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.

• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225

  Pediatrics

  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD
• Medical Clinic of North Texas PLLC

  • Radiation Oncology Clinic/Center
  • Arlington, TX
  • NPI 1184131625
  NPD (past)
• Somers Medical PLLC

  dba Somers Urgent Care

  • Urgent Care Clinic/Center
  • Longview, TX
  • NPI 1134817950

  Pediatrics

  NPD (past)
• Somers Pediatrics

  • Pediatrics Physician
  • Longview, TX
  • NPI 1245733492
  NPD (past)

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

{
    "created_epoch": "1317600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763337600000",
    "number": "1245514785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3564 N FOURTH ST STE A",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050039",
            "telephone_number": "903-230-3311",
            "fax_number": "903-230-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3564 N FOURTH ST STE A",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050039",
            "telephone_number": "903-230-3311",
            "fax_number": "903-230-3312"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3564 N Fourth St Ste B",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756050039",
            "country_code": "US",
            "telephone_number": "903-231-3144",
            "fax_number": "903-231-3230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EATON",
        "first_name": "LACY",
        "middle_name": "KENNEDY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-03",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA07377",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "PA07377",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Texas Rehabilitation, LLC
• East Texas Sinus and Dizziness Center, PLLC
• East Texas Urology, PLLC
• East TX LLC
• Easttexrx LLC (Spring Hill Pharmacy)
• Myra Tan Echave, PT
• Ravikumar Hanumanthaiah Edalur, M.D
• Shylashree Chikkamuniyappa Edalur, MD
• Carlita Eddington, LMT
• Edu-Dula, Inc. (The Pediatric Rehab Center)

• Physician Assistant in Longview, TX
• Providers in Longview, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; 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.