Lacey Gardner, PA-C
Physician Assistant in Paris, TX. Individual provider (NPI-1).
NPI number1790226504
StatusActive
Last updated in NPPESJul 16, 2020
Details
- NPI
- 1790226504
- Entity type
- Individual (NPI-1)
- Name
- Lacey Gardner
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 13, 2017
- Certification date
- Jul 16, 2020
- Last updated
- Jul 16, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA11191 | TX | Yes |
Practice location
865 Deshong DrParis, TX 75460-9313
Phone 903-785-4521
Mailing address
Po Box 732Antlers, OK 74523-0732
Phone 580-579-3314
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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