MRS. LACEY R PREVALLET (NPI# 1245782549) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245782549 |
| Entity Type | Individual |
| Full Name | MRS. LACEY R PREVALLET |
| Other Name | MS. LACEY R HERMAN |
| Credential | FNP-BC |
| Practice Address |
530 N Middle St Farmington MO 63640-1570 |
| Mailing Address |
750 Clover Ln Farmington MO 63640-3336 |
| Practice Telephone | 5737563000 |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2017-02-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WP0809X |
Registered Nurse Specialization: Psych/Mental Health, Adult |
2011032659 | MO | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
2017002573 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1245782549 | 05 |
| Street Address |
530 N MIDDLE ST |
| City | FARMINGTON |
| State | MO |
| Zip Code | 63640-1570 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689658189 | Gary F Ward | Chiropractor | 530 N Middle St, Farmington, MO 63640-1570 | 2005-11-30 |
| 1366093312 | Sarah Hull | Nurse Practitioner | 530 N Middle St, Farmington, MO 63640-1570 | 2019-09-21 |
| 1760032965 | Caring Wounds LLC | Registered Nurse | 530 N Middle St, Farmington, MO 63640-1570 | 2019-09-19 |
| 1750563722 | Great Mines Health Center | Family Medicine | 530 N Middle St, Farmington, MO 63640-1570 | 2007-12-03 |
| 1861692428 | Adam Paul Overcast | Chiropractor | 530 N Middle St, Farmington, MO 63640-1570 | 2007-07-23 |
| 1003016676 | Desired Health Chiropractic, LLC | Chiropractor | 530 N Middle St, Farmington, MO 63640-1570 | 2007-07-23 |
| 1629052634 | Lois E Ward | Chiropractor | 530 N Middle St, Farmington, MO 63640-1570 | 2005-12-02 |
| 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 R PREVALLET.
| 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.