Provider Demographics
NPI:1427615087
Name:THOMAS, LACY CAVALIER (FNP)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:CAVALIER
Last Name:THOMAS
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:
Other - Last Name:CAVALIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-0487
Mailing Address - Country:US
Mailing Address - Phone:225-635-5848
Mailing Address - Fax:225-635-9595
Practice Address - Street 1:5326 OAK ST
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-4510
Practice Address - Country:US
Practice Address - Phone:225-635-5848
Practice Address - Fax:225-635-9595
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2500520Medicaid