Provider Demographics
NPI:1538683636
Name:HOSAY, LACY LEE RAE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LACY
Middle Name:LEE RAE
Last Name:HOSAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 E GANNON DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2611
Mailing Address - Country:US
Mailing Address - Phone:636-282-0380
Mailing Address - Fax:877-592-0806
Practice Address - Street 1:1153 E GANNON DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2611
Practice Address - Country:US
Practice Address - Phone:636-282-0380
Practice Address - Fax:877-592-0806
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017025491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017025491OtherMO LICENSE