Provider Demographics
NPI:1689113540
Name:CASE, LACEY HILLERMAN (NP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:HILLERMAN
Last Name:CASE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-4662
Mailing Address - Fax:417-347-9453
Practice Address - Street 1:203 NW R D MIZE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2510
Practice Address - Country:US
Practice Address - Phone:816-220-1117
Practice Address - Fax:816-228-2053
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016025285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily