| Doctor Name: | LACEY BLAKENEY |
| NPI Number: | 1326457151 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | R872620 |
| Business Practice Address: | 1242 Highway 29 N Ellisville, MS - 394378763 |
| Business Phone Number: | 6012689393 |
| Business Fax Number: | |
| Mailing Address: | 39 Franklin Rd Ste 300, HATTIESBURG |
| State: | MS |
| Postal Code: | 394021588 |
| Phone Number: | 6012689393 |
| Fax Number: | 6012689559 |
| NPI Enumeration Date: | 08/06/2014 |
| NPI Last Update Date: | 01/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R872620 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |