Basic Information
| Provider Information | |||||||||
| NPI: | 1619063161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | LACEY | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | APRN, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4864 JACKSON STREET | ||||||||
| Address2: | DEPARTMENT OF FAMILY MEDICINE | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712020000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183307650 | ||||||||
| FaxNumber: | 3183307648 | ||||||||
| Practice Location | |||||||||
| Address1: | 4864 JACKSON STREET | ||||||||
| Address2: | DEPARTMENT OF FAMILY MEDICINE | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712020000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183307650 | ||||||||
| FaxNumber: | 3183307648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 08/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APO04964 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1584941 | 05 | LA | MEDICAID |