Individual
LACIE A BRACKEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
201 BAKER BLVD, LELAND, MS 38756-3401
(662) 686-4121
(662) 686-4770
Mailing address
201 BAKER BLVD, LELAND, MS 38756-3401
(662) 686-4121
(662) 686-4770
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R858018
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006425036
—
MS
05
—
06425036
—
MS
Enumeration date
09/26/2012
Last updated
07/08/2026
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