Provider Demographics
NPI:1184252777
Name:CONWAY, LACEY ANNE (FNP)
Entity type:Individual
Prefix:MS
First Name:LACEY
Middle Name:ANNE
Last Name:CONWAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:JURICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 TYNE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3445
Mailing Address - Country:US
Mailing Address - Phone:502-436-5989
Mailing Address - Fax:
Practice Address - Street 1:300 HIGH POINT CT
Practice Address - Street 2:
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-6560
Practice Address - Country:US
Practice Address - Phone:502-955-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014392207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty