Individual
LANISE COOPER LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 925-6805
(601) 926-4978
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 925-6805
(601) 926-4978
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R864303
MS
Other
Enumeration date
07/10/2009
Last updated
10/11/2012
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