Provider Demographics
NPI:1982005146
Name:LACY, MELINDA MICHELLE (RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MICHELLE
Last Name:LACY
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 E ROCK HAVEN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-4414
Mailing Address - Country:US
Mailing Address - Phone:816-380-7470
Mailing Address - Fax:816-380-3291
Practice Address - Street 1:2820 E ROCK HAVEN RD STE 210
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-4414
Practice Address - Country:US
Practice Address - Phone:816-380-7470
Practice Address - Fax:816-380-3291
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014031475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily