Provider Demographics
NPI:1720458961
Name:KEMP, LACIE OURSO
Entity Type:Individual
Prefix:
First Name:LACIE
Middle Name:OURSO
Last Name:KEMP
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 1:6750 POYDRAS BAYOU RD
Mailing Address - Street 2:
Mailing Address - City:ERWINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70729-9700
Mailing Address - Country:US
Mailing Address - Phone:225-247-5113
Mailing Address - Fax:
Practice Address - Street 1:1919 HOSPITAL ROAD
Practice Address - Street 2:STE A
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760
Practice Address - Country:US
Practice Address - Phone:225-638-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator