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Lacey Marie Irias

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

225 Baldwin Ave, Charlotte, NC 28204-3109

PECOS Enrollment

This provider is enrolled in PECOS as LACEY IRIAS.

Based on the most recent information from CMS, provider Lacey Marie Irias is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:59 PM.

Profile Details

Provider ID
1346088663
Provider Type
Individual
Full Name
Irias, Lacey Marie
Credential
DNP, FNP-C

Gender
Female
Sole Proprietor
No
Enumeration Date
7/19/2024
Last Updated
11/11/2024

Contact Information

Practice Location

225 Baldwin Ave, Charlotte, NC 28204-3109

(704) 376-1605

(704) 335-8448

Mailing Location

225 Baldwin Ave, Charlotte, NC 28204-3109

(704) 376-1605

(704) 335-8448

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5020438 North Carolina

Provider Identifiers

ID	Description	Issuer
ID 1346088663	Description Medicaid	Issuer Unlisted North Carolina

Lacey Marie Irias

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Short, Susannah Kelly

Finnigan, Mary Kathleen

Traverso, Katrina

Palmer, Scott Mikael

Morford, Brooke Ann

Shah, Catherine Duffy

Simmons, Maya

Kinzer, Eva Marie

Whittington, Ashley

Griffin, Samantha Murray