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Individual

MRS. LACEY DANIELLE KEETH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, FNP-C

Contact information

Practice address
1643 CARTER STREET, SUITE #1, VIDALIA, LA 71373
(318) 336-8707
(318) 336-8876
Mailing address
1643 CARTER STREET, SUITE #1, VIDALIA, LA 71373
(318) 336-8707
(318) 336-8876

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP09734
LA
363LF0000X
Family Nurse Practitioner
R872599
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2460561
LA
Enumeration date
09/12/2012
Last updated
10/05/2021
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