Individual
MRS. LACEY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
7245 RAIDER RD STE C, BONNE TERRE, MO 63628-3767
(573) 358-4600
(573) 358-4654
Mailing address
PO BOX 957683, SAINT LOUIS, MO 63195-7683
(573) 358-4600
(573) 358-4654
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2013037701
MO
363LF0000X
Family Nurse Practitioner
2013037701
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008021920
RN LICENSE
MO
01
—
2013017822
ANCC
MO
01
—
2013037701
FNP LICENSE
MO
Enumeration date
10/22/2013
Last updated
09/17/2025
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