Healthcare Provider Details

I. General information

NPI: 1730762915
Provider Name (Legal Business Name): LACEY CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACEY SHREVE MD

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OCHSNER BLVD
COVINGTON LA
70433-8107
US

IV. Provider business mailing address

300 S WASHINGTON AVE
GREENVILLE MS
38701-4719
US

V. Phone/Fax

Practice location:
  • Phone: 985-875-2828
  • Fax:
Mailing address:
  • Phone: 225-907-7507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSHRE-AN9HP9
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number343381
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: