Provider Demographics
NPI:1972864148
Name:BLESSITT, LACEY LANE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LACEY
Middle Name:LANE
Last Name:BLESSITT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 S COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3506
Mailing Address - Country:US
Mailing Address - Phone:662-207-5064
Mailing Address - Fax:
Practice Address - Street 1:15 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5364
Practice Address - Country:US
Practice Address - Phone:601-304-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867653363LF0000X
MS867653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily