Active NPI
Lacey Kennon, APRN
- Pediatric Nurse Practitioner
- Monroe, LA
National Provider Identifier
1528642014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 213079
- Practice address
- 622 Riverside Dr
Monroe, LA 71201-6211 - Phone
- (318) 398-0945
- NPI assigned
- May 10, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 213079 | LA | Primary |
Addresses
Primary practice location
622 Riverside Dr
Monroe, LA 71201-6211
Mailing address
622 Riverside Dr
Monroe, LA 71201-6211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 213079 | LA | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623715200000",
"number": "1528642014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "622 RIVERSIDE DR",
"city": "MONROE",
"state": "LA",
"postal_code": "712016211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "622 RIVERSIDE DR",
"city": "MONROE",
"state": "LA",
"postal_code": "712016211",
"telephone_number": "318-398-0945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNON",
"first_name": "LACEY",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-10",
"last_updated": "2021-06-15",
"certification_date": "2021-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "LA",
"license": "213079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.