Healthcare Provider Details

I. General information

NPI: 1033034525
Provider Name (Legal Business Name): LACEE BLADY RN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14474 JIM CORE RD
FOLSOM LA
70437-3135
US

IV. Provider business mailing address

14474 JIM CORE RD
FOLSOM LA
70437-3135
US

V. Phone/Fax

Practice location:
  • Phone: 985-966-0861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN154227
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: