Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Miss. Lacey Lee Wilson

Individual provider Nurse Practitioner · NPI 1104646793

Miss. Lacey Lee Wilson is a Nurse Practitioner in Phoenix, Arizona. Practices as a sole proprietor. Licensed in Arizona.

Licensed in
AZ
In the registry since
2024

Practice location Address checks out

4859 N 20th St
Phoenix, AZ 85016-4707
Phone: (602) 669-3850
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 315636 (AZ)

Record details

NPI number1104646793
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedOctober 16, 2024
Last updated in NPPESOctober 16, 2024
Certification dateOctober 16, 2024

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