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

Stacey Mills Lake, NP

Individual provider Family Nurse Practitioner · NPI 1154003473

Stacey Mills Lake, NP is a Nurse Practitioner in Holladay, Utah. Qualified in 2023, 3 years ago. Practices with Granger Medical Clinic PC, a 191-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
3
Licensed in
UT
In the registry since
2023
Specialties on file
3
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

999 E Murray Holladay Rd Ste 207
Holladay, UT 84117-5093
Phone: (801) 268-2584
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence 5641317-4405 (UT)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 5641317-4405 (UT)
Nurse Practitioner Taxonomy 363L00000X · Licence 5641317-4405 (UT)

Record details

NPI number1154003473
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorNo
NPI enumeratedAugust 4, 2023
Last updated in NPPESJanuary 22, 2025
Certification dateJanuary 22, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Granger Medical Clinic Pc — 191 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Holladay