Healthcare Provider Details

I. General information

NPI: 1548142565
Provider Name (Legal Business Name): ANNAH CATHERINE LACEFIELD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNAH CATHERINE LACEFIELD FNP-C

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E COMMERCE ST
HERNANDO MS
38632-2456
US

IV. Provider business mailing address

107 BROOKSIDE DR
SENATOBIA MS
38668-1506
US

V. Phone/Fax

Practice location:
  • Phone: 662-298-2238
  • Fax:
Mailing address:
  • Phone: 662-292-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number907977
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number39158
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: