Healthcare Provider Details

I. General information

NPI: 1619063161
Provider Name (Legal Business Name): LACEY N MORRIS APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 JACKSON STREET DEPARTMENT OF FAMILY MEDICINE
MONROE LA
71202-0000
US

IV. Provider business mailing address

4864 JACKSON STREET DEPARTMENT OF FAMILY MEDICINE
MONROE LA
71202-0000
US

V. Phone/Fax

Practice location:
  • Phone: 318-330-7650
  • Fax: 318-330-7648
Mailing address:
  • Phone: 318-330-7650
  • Fax: 318-330-7648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO04964
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: