Active NPI
Lacy Robertson, RN, IBCLC
- Family Nurse Practitioner
- Granbury, TX
National Provider Identifier
1467905471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP145224
- Practice address
- 112 Maverick CT
Granbury, TX 76049-1381 - Phone
- (888) 731-8994
- NPI assigned
- Jul 26, 2016
- Last updated
- Jan 17, 2025
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP145224 | TX | Primary |
| Lactation Consultant (Registered Nurse) | 163WL0100X | L-87846 | TX | |
| Lactation Consultant (Registered Nurse) | 163WL0100X | 809899 | TX |
Addresses
Primary practice location
112 Maverick CT
Granbury, TX 76049-1381
Mailing address
23740 Champion Dr
Lindale, TX 75771-5554
Phone (903) 714-5864
Other practice location 1
111 N Orange Ave Ste 800
Orlando, FL 32801-2381
Phone (888) 731-8994
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 809899 | TX | MD | Lactation Consultant (Registered Nurse) |
| L-87846 | TX | MD | Lactation Consultant (Registered Nurse) |
| AP145224 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrative Womens Care PC | Past | Accepting new patients |
Interoperability endpoints
- lacy.robertson.1@27069.direct.athenahealth.com
Organizations & group practices 1
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.
-
dba Midi Health PC
- Obstetrics & Gynecology Physician
- Palo Alto, CA
- NPI 1972266732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737072000000",
"number": "1467905471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23740 CHAMPION DR",
"city": "LINDALE",
"state": "TX",
"postal_code": "757715554",
"telephone_number": "903-714-5864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 MAVERICK CT",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760491381",
"telephone_number": "888-731-8994"
}
],
"practiceLocations": [
{
"address_1": "111 N Orange Ave Ste 800",
"address_purpose": "LOCATION",
"city": "Orlando",
"state": "FL",
"postal_code": "328012381",
"country_code": "US",
"telephone_number": "888-731-8994",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROBERTSON",
"first_name": "LACY",
"credential": "RN, IBCLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-26",
"last_updated": "2025-01-17",
"certification_date": "2025-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "AP145224",
"primary": true
},
{
"code": "163WL0100X",
"taxonomy_group": "",
"desc": "Registered Nurse, Lactation Consultant",
"state": "TX",
"license": "L-87846",
"primary": false
},
{
"code": "163WL0100X",
"taxonomy_group": "",
"desc": "Registered Nurse, Lactation Consultant",
"state": "TX",
"license": "809899",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Granbury, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.