Individual
LACEY MCKEOWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
940 HOLLY ST, ORANGEBURG, SC 29115-4930
(803) 536-2725
(803) 534-3118
Mailing address
940 HOLLY ST, ORANGEBURG, SC 29115-4930
(803) 536-2725
(803) 534-3118
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
20741
SC
Other
Enumeration date
02/09/2017
Last updated
02/09/2017
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