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MISS LACEY LEE WILSON
NPI 1104646793
Nurse Practitioner in Phoenix, AZ

Active since October 16, 2024
4859 N 20TH ST, PHOENIX, AZ 85016(602) 669-3850 Get Directions Write a Review

NPPES record last updated: October 16, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Miss Lacey Lee Wilson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISS LACEY LEE WILSON (NPI 1104646793) is an individual nurse practitioner in Phoenix, Arizona, licensed in Arizona (315636) and active in the NPI registry since October 2024.

NPPES Registry Identity

NPI1104646793
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameMISS LACEY LEE WILSON
Location Address4859 N 20TH STPhoenix, AZ 85016-4707
Mailing Address735 E Gary LnPhoenix, AZ 85042-6647 · (602) 814-2852
Phone(602) 669-3850
Sole ProprietorYes
Enumeration DateOctober 16, 2024
NPPES CertifiedOctober 16, 2024
✔ NPI 1104646793 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in AZ · 315636
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
4859 N 20TH ST, Phoenix, AZ 85016
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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DAVID JOSEPH DOPERAK DC
Chiropractor
4859 N 20TH ST
PHOENIX, AZ 85016
Maricopa County (602) 689-0869

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lacey Wilson's NPI number?

The NPI number for Lacey Wilson is 1104646793. It was assigned to this individual provider in the NPPES registry on October 16, 2024.

Where is Lacey Wilson located?

Lacey Wilson practices at 4859 N 20th St, Phoenix, AZ 85016. The listed phone number is (602) 669-3850.

What is Lacey Wilson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

When was this NPI record last updated?

The NPPES record for Lacey Wilson was last updated on October 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.