LACEY KAY WILSON (DNP) – Nurse Practitioner, NPI 1720455660
Nurse Practitioner
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for LACEY KAY WILSON (DNP)
3001 St Anthony Way
Pendleton, OR 97801
Phone: (541) 966-0535
Fax: (541) 278-4597
Type: Location
2801 ST ANTHONY WAY
PENDLETON, OR 978013800
Phone: (541) 966-0535
Fax: (541) 278-4597
Type: Mailing
3001 ST ANTHONY WAY
PENDLETON, OR 97801
Phone: (541) 966-0535
Fax: (541) 278-4597
Type: Location
13400 E SHEA BLVD
SCOTTSDALE, AZ 852595499
Phone: (480) 301-8000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $92.
Total Amount is formed as General ($92) + Research ($0) + Ownership ($0) = $92.
Last reported payment date: 2024-11-19 • Largest payer in this snapshot: Kiniksa Pharmaceuticals International, plc ($92).
Total Amount
$92
General + Research + Ownership
Payments
1
Total payment records
General Amount
$92
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Kiniksa Pharmaceuticals International, plc | $92 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-05
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20241105001479 | I | Nurse Practitioner | AZ | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97801)
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