Lacey Sullivan, FNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2013037701 Issued in MO

Practice address

7245 Raider Rd Ste C
Bonne Terre, MO 63628-3767

Phone

(573) 358-4600

Fax

(573) 358-4654

NPI assigned

Oct 22, 2013

Last updated

Sep 17, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Parkland Health CenterGroup PAC ID 1951219237, 42 clinicians

Ste Genevieve County Memorial HospitalGroup PAC ID 3274432802, shared by 9 NPIs, 74 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
• Direct secure messaging: laceysullivan@mhccaremail.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Parkland Health Center

  • General Practice Physician
  • Farmington, MO
  • NPI 1922016112
  Medicare reassignment Care Compare group NPD
• Mineral Area Pain Center, P.C.

  • Physical Medicine & Rehabilitation Physician
  • Farmington, MO
  • NPI 1417973660
  Medicare reassignment NPD
• Ste Genevieve County Memorial Hospital

  • Critical Access Hospital
  • Ste Genevieve, MO
  • NPI 1073587655
  Medicare reassignment NPD
• Ste Genevieve County Memorial Hospital

  dba Apple Kids Pediatrics

  • Rural Health Clinic/Center
  • Ste Genevieve, MO
  • NPI 1730238551
  Medicare reassignment NPD
• Ste Genevieve County Memorial Hospital

  dba Family Heath Care Pointe Basse

  • Rural Health Clinic/Center
  • Ste Genevieve, MO
  • NPI 1801817416
  Medicare reassignment NPD
• Ste Genevieve County Memorial Hospital

  dba Womens Health Center

  • Rural Health Clinic/Center
  • Ste Genevieve, MO
  • NPI 1992875249
  Medicare reassignment NPD
• Xiaohui's Medical, LLC

  dba Select Pain and Spine Center

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Farmington, MO
  • NPI 1518297977
  Medicare reassignment NPD
• Ste Genevieve County Memorial Hospital

  dba Ste Genevieve Surgical Care

  • Surgery Physician
  • Ste Genevieve, MO
  • NPI 1619026580
  Medicare reassignment
• Analytical Pathology Services LTD

  • Anatomic Pathology & Clinical Pathology Physician
  • Saint Louis, MO
  • NPI 1558343673
  NPD
• Parkland Health Center

  dba Parkland Health Center Primary Care Clinic

  • Rural Health Clinic/Center
  • Farmington, MO
  • NPI 1427806413
  NPD
• Ste Genevieve County Memorial Hospital

  dba Bloomsdale Family Health Care

  • Rural Health Clinic/Center
  • Bloomsdale, MO
  • NPI 1184658387
  NPD
• Ste Genevieve County Memorial Hospital

  dba Ste Genevieve Specialty Clinic

  • Medical Specialty Clinic/Center
  • Ste Genevieve, MO
  • NPI 1508293226
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758067200000",
    "number": "1174951503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 957683",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631957683",
            "telephone_number": "573-358-4600",
            "fax_number": "573-358-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7245 RAIDER RD STE C",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636283767",
            "telephone_number": "573-358-4600",
            "fax_number": "573-358-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "LACEY",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-22",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2013037701",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2013037701",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC",
            "identifier": "2013017822",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "2008021920",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FNP LICENSE",
            "identifier": "2013037701",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7245 Raider Rd Ste C",
            "city": "Bonne Terre",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636283767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Roxanne Marie Simmons, M.A., CCC-SLP
• Annetta Slover
• Michelle D Spray, O.D.
• Cheyenne Spurgin, PTA
• St Joe Manor Inc
• Katelyn Abigail Swaringim
• Town & Country Grocers of Fredericktown Mo Inc (Country Mart Pharmacy)
• Visage Studios, LLC (Visage Custom Prosthetics)
• Walgreen Co (Walgreens #15821)
• Kelsie Hereora Ann Okeroa Walker

• Nurse Practitioner in Bonne Terre, MO
• Providers in Bonne Terre, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.