Provider Demographics
NPI:1003287848
Name:GAINES, LACOSTA KAY (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LACOSTA
Middle Name:KAY
Last Name:GAINES
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBINA
Mailing Address - State:MO
Mailing Address - Zip Code:63468-1404
Mailing Address - Country:US
Mailing Address - Phone:573-588-4131
Mailing Address - Fax:573-588-4876
Practice Address - Street 1:400 S CENTER ST
Practice Address - Street 2:
Practice Address - City:SHELBINA
Practice Address - State:MO
Practice Address - Zip Code:63468-1404
Practice Address - Country:US
Practice Address - Phone:573-588-4131
Practice Address - Fax:573-588-4876
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015035184363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care