Sullivan, Lacey

Sullivan, Lacey is an individual health care provider with primary practice located at 7245 Raider Rd Ste C , Bonne Terre MO 63628-3767. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Sullivan, Lacey can be contacted via phone (573) 358-4600.

Contact Information

Primary practice address
7245 Raider Rd Ste C Bonne Terre MO 63628-3767
Phone: (573) 358-4600
Fax: (573) 358-4654
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 2013037701 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2013037701 Missouri

Profile Details

NPI number 1174951503
LBN Legal business name Sullivan, Lacey
Credentials FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 22nd, 2013
Last updated Sep 17th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174951503 NPPES
Missouri Other 2013037701 FNP LICENSE
Missouri Other 2013017822 FNP LICENSE
Missouri Other 2008021920 FNP LICENSE

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