Healthcare Provider Details

I. General information

NPI: 1780412528
Provider Name (Legal Business Name): LACY RENEE' DUPUY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 MEDICAL CENTER DR
BATON ROUGE LA
70816-3246
US

IV. Provider business mailing address

42402 PALMSTONE AVE
PRAIRIEVILLE LA
70769-6291
US

V. Phone/Fax

Practice location:
  • Phone: 225-754-5200
  • Fax:
Mailing address:
  • Phone: 225-341-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236704
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: