Lacey Banther, LPN

Individual provider Active NPI Licensed Practical Nurse · Chattanooga, TN

NPI 1609286376 · NPPES record last updated May 5, 2014

Key facts

NPI
1609286376
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
LPN-8275166 (TN)
Practice address
3074 Hickory Valley Rd
Chattanooga, TN 37421-1265
Phone
(423) 622-1551
NPI assigned
May 5, 2014
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
LPN-8275166TNMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X LPN-8275166 TN Yes

Addresses

Primary practice location

3074 Hickory Valley Rd
Chattanooga, TN 37421-1265

Mailing address

PO Box 8114
Chattanooga, TN 37414-0114

Other providers in Chattanooga, TN

All providers in Chattanooga, TN · Licensed Practical Nurse in Tennessee

Sources for this page

Verify at the official NPI Registry.