Provider Demographics
NPI:1346867785
Name:EARLEY, LACRESHA CLAY
Entity Type:Individual
Prefix:
First Name:LACRESHA
Middle Name:CLAY
Last Name:EARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 WARREN DR
Mailing Address - Street 2:STE B
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7158
Mailing Address - Country:US
Mailing Address - Phone:318-217-6521
Mailing Address - Fax:
Practice Address - Street 1:104 NORTHPARK DRIVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203
Practice Address - Country:US
Practice Address - Phone:318-600-3456
Practice Address - Fax:318-600-3456
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213885363LF0000X
LA2133385363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health