Individual
LACY CULVER VINCENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4396 HIGHWAY 80, RUSTON, LA 71270-8948
(318) 550-8928
Mailing address
4396 HIGHWAY 80, RUSTON, LA 71270-8948
(318) 251-4659
(318) 513-3612
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
310464
LA
Other
Enumeration date
11/05/2018
Last updated
03/19/2020
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