Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 684218 | TX |
NPI | 1003235672 |
---|---|
Provider Name | Lacy Pitchford |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 14/04/2021 |