Individual
LACY BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1751 JACKSON ST, ALEXANDRIA, LA 71301-6433
(318) 445-5678
Mailing address
1751 JACKSON ST, ALEXANDRIA, LA 71301-6433
(318) 445-5678
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
LA
Other
Enumeration date
06/18/2026
Last updated
06/18/2026
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