Prevallet, Lacey R

Prevallet, Lacey R is an individual health care provider with primary practice located at 530 N Middle St , Farmington MO 63640-1570. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Psychiatric/Mental Health, Adult, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Prevallet, Lacey R can be contacted via phone (573) 756-3000.

Contact Information

Primary practice address
530 N Middle St Farmington MO 63640-1570
Phone: (573) 756-3000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Psychiatric/Mental Health, Adult 163WP0809X 2011032659 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2017002573 Missouri

Profile Details

NPI number 1245782549
LBN Legal business name Prevallet, Lacey R
Credentials FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2016
Last updated Feb 15th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245782549 NPPES
Missouri MEDICAID 1245782549

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