Provider Demographics
NPI:1982156154
Name:STOGSDILL, LACEY M (FNP-BC)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:M
Last Name:STOGSDILL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPBC
Mailing Address - Street 1:7245 RAIDER RD STE C
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-3767
Mailing Address - Country:US
Mailing Address - Phone:573-359-4600
Mailing Address - Fax:
Practice Address - Street 1:7245 RAIDER RD STE C
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-3767
Practice Address - Country:US
Practice Address - Phone:573-359-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016032506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily