Provider Demographics
NPI:1366656043
Name:MCLAURIN, LACEY LEIGH (MS RD)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:LEIGH
Last Name:MCLAURIN
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 VIOLET DR
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437
Mailing Address - Country:US
Mailing Address - Phone:601-319-5526
Mailing Address - Fax:
Practice Address - Street 1:71 VIOLET DR
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-0000
Practice Address - Country:US
Practice Address - Phone:601-319-5526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1129133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered