Individual
MRS. LACIE STAFFORD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4600 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70508-6902
(337) 521-9127
Mailing address
4600 AMBASSADOR CAFFERY PKWY, LAFAYETTE, LA 70508-6902
(337) 521-9127
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200503
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA.200503
STATE LICENSE NUMBER
LA
Enumeration date
10/11/2011
Last updated
03/17/2018
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