Healthcare Provider Details

I. General information

NPI: 1871156067
Provider Name (Legal Business Name): LACIE STELLY WALKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD
BATON ROUGE LA
70808-4375
US

IV. Provider business mailing address

10101 PARK ROWE AVE STE 200
BATON ROUGE LA
70810-1685
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-6565
  • Fax:
Mailing address:
  • Phone: 225-769-2200
  • Fax: 833-756-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number203967
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: