Individual
LACEY JO CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1952 NEW CREEK HWY, KEYSER, WV 26726-7494
(304) 597-1258
Mailing address
1952 NEW CREEK HWY, KEYSER, WV 26726-7494
(304) 597-3522
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
70974
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70974
—
WV
Enumeration date
12/19/2022
Last updated
12/19/2022
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