Individual
MS. LACEY ANN STEVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6090
Mailing address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6090
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2018026933
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420074828
—
MO
Enumeration date
04/24/2019
Last updated
01/15/2025
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