Provider Demographics
NPI:1619063161
Name:MORRIS, LACEY N (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:N
Last Name:MORRIS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4864 JACKSON STREET
Mailing Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-0000
Mailing Address - Country:US
Mailing Address - Phone:318-330-7650
Mailing Address - Fax:318-330-7648
Practice Address - Street 1:4864 JACKSON STREET
Practice Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-0000
Practice Address - Country:US
Practice Address - Phone:318-330-7650
Practice Address - Fax:318-330-7648
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO04964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1584941Medicaid
LA4H945F600Medicare PIN
LA1584941Medicaid