Individual provider · Type 1 NPI
Lacey Sullivan, FNP-BC
Nurse Practitioner · Bonne Terre, MO
Practice location
7245 Raider Rd Ste C
Bonne Terre, MO 63628-3767
Fax (573) 358-4654
Mailing address
PO Box 957683
St. Louis, MO 63195-7683
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner Primary | 363L00000X | 2013037701 (MO) |
| Family Nurse Practitioner | 363LF0000X | 2013037701 (MO) |
Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…
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About NPI 1174951503
Lacey Sullivan, FNP-BC's National Provider Identifier is 1174951503, issued on Oct 22, 2013. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Bonne Terre, MO. The record was last updated on Sep 17, 2025.