MRS. LACEY SULLIVAN FNP-BC NPI 1174951503

NPI Information

  • NPI: 1174951503
  • Provider Name: MRS. LACEY SULLIVAN, FNP-BC
  • Classification: Nurse Practitioner - 363L00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 7245 RAIDER RD STE C
    BONNE TERRE, MO
    ZIP 63628
  • Phone: (573) 358-4600

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NPI Details

MRS. Lacey Sullivan, FNP-BC is a nurse practitioner in Bonne Terre, MO with 13 years of experience. The provider is (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 with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. MRS. Lacey Sullivan, FNP-BC NPI is 1174951503. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

7245 RAIDER RD STE C
BONNE TERRE, MO
ZIP 63628-767
Phone: (573) 358-4600
Fax: (573) 358-4654

The NPI 1174951503 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/22/2013 and was last updated on 9/17/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse Practitioner2013037701MISSOURIYes
2363LF0000XNurse PractitionerFamily2013037701MISSOURINo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12013037701OTHERMISSOURIFNP LICENSE
22013017822OTHERMISSOURIANCC
32008021920OTHERMISSOURIRN LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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