MRS. LACEY SULLIVAN (NPI# 1174951503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174951503 |
| Entity Type | Individual |
| Full Name | MRS. LACEY SULLIVAN |
| Credential | FNP-BC |
| Practice Address |
618 Maple Valley Dr Farmington MO 63640 |
| Mailing Address |
608 Maple Valley Dr Farmington MO 63640-1976 |
| Practice Telephone | 5737563400 |
| Practice Fax Number | 5737560800 |
| Mailing Telephone | 5737563400 |
| Mailing Fax Number | 5737560800 |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2020-02-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
2013037701 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | ANCC | 2013017822 | 01 |
| MO | RN LICENSE | 2008021920 | 01 |
| MO | FNP LICENSE | 2013037701 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194070235 | Lacey Jay Sullivan | Pharmacist | 21132 N 36th Pl, Phoenix, AZ 85050-8386 | 2012-07-15 |
| 1114412103 | Lacey Sullivan | Dentist | 1141 Jasper Dennis Rd, Clanton, AL 35045 | 2018-06-22 |
| 1962707745 | Lacey Sullivan | Pathology | 2809 Denny Ave, Pascagoula, MS 39581 | 2011-01-25 |
| Street Address |
618 MAPLE VALLEY DR |
| City | FARMINGTON |
| State | MO |
| Zip Code | 63640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770577421 | Stephen W Orr | Chiropractor | 618 Maple Valley Dr, Farmington, MO 63640-1976 | 2005-09-08 |
| 1235527763 | Rebecca Buchanan | Nurse Practitioner | 618 Maple Valley Dr, Farmington, MO 63640-1976 | 2015-01-06 |
| 1518297977 | Xiaohui's Medical, LLC | Physical Medicine & Rehabilitation | 618 Maple Valley Dr, Farmington, MO 63640-1976 | 2010-01-07 |
| 1386703197 | Mark Medley | Chiropractor | 618 Maple Valley Dr, Farmington, MO 63640-1976 | 2006-12-07 |
| 1245276252 | Xiaohul Fan | Physical Medicine & Rehabilitation | 618 Maple Valley Dr, Farmington, MO 63640-1976 | 2006-06-20 |
| 1134171531 | James N Moore | Family Medicine | 618 Maple Valley Dr, Farmington, MO 63640-1976 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545254 | Brenda S Halton | Nurse Practitioner | 1010 West Columbia Street, Farmington, MO 63640 | 2020-10-13 |
| 1619519089 | Stacey Nicole Gillette | Counselor | 17885 Hart Pinkston Rd, Farmington, MO 63640 | 2019-10-17 |
| 1346890696 | Christopher Ryan Massey | Social Worker | 607 Pine St., Farmington, MO 63640 | 2019-09-18 |
| 1457909376 | Clarice Ogden | Social Worker | 203 South Washington Street, Farmington, MO 63640 | 2019-09-04 |
| 1861979718 | Clint Thebeau | In Home Supportive Care | 1276 W Liberty St, Farmington, MO 63640 | 2018-07-24 |
| 1023500600 | Lynn Machelle Knox | Counselor | 219 W Columbia St, Farmington, MO 63640 | 2018-05-31 |
| 1235620576 | Kim Bazzell | Registered Nurse | 1565 Ste. Genevieve Ave., Farmington, MO 63640 | 2018-05-22 |
| 1164919742 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | 774 Market St, Farmington, MO 63640 | 2018-04-18 |
| 1184127813 | Michelle Lynette Corvallis | Chiropractor | 17 South Franklin St., Farmington, MO 63640 | 2018-03-08 |
| 1992206213 | Farmington Vision Care LLC | Optometrist | 110 E Harrison St, Farmington, MO 63640 | 2018-02-22 |
| Find all providers in zip 63640 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508466368 | Amalia Jo Folland Harvey | Nurse Practitioner | 19883 Evensong Ct, Farmington, MN 55024-8688 | 2020-10-29 |
| 1356957179 | Jared Kunz | Nurse Practitioner | 635 Braning Dr, Farmington, MO 63640-7783 | 2020-09-17 |
| 1700427382 | Jessinna Nielson | Nurse Practitioner | 722 Shepard Ln Ste 102, Farmington, UT 84025-3845 | 2019-10-04 |
| 1831744200 | Rachelle Andersen Spurlin | Nurse Practitioner | 359 Frontier Rd, Farmington, UT 84025-2613 | 2019-08-02 |
| 1033770698 | Tiffany Otto | Nurse Practitioner | 27o Farmington Avenue, # 309, Farmington, CT 06032 | 2019-06-25 |
| 1164980181 | Adam Thomas Creer | Nurse Practitioner | 696 N 40 E Apt 2, Farmington, UT 84025 | 2019-03-08 |
| 1235627936 | Swayzee Lei Ramage | Nurse Practitioner | 4801 N Butler Ave Ste 8102, Farmington, NM 87401-0818 | 2018-04-27 |
| 1306345368 | Joy Wolfe | Nurse Practitioner | 850 Maple Valley Drive, Farmington, MO 63640 | 2018-02-06 |
| 1518482769 | Million B Mesfun | Nurse Practitioner | 4405 Atlantic St, Farmington, NM 87402-1750 | 2017-08-09 |
| 1568912129 | Kelly M Roberts | Nurse Practitioner | 555 W Pine Street, Farmington, MO 63640 | 2016-10-07 |
| Find all providers in FARMINGTON | ||||
| City | FARMINGTON |
| Zip Code | 63640 |
Please comment or provide details below to improve the information on MRS. LACEY SULLIVAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.