Provider Demographics
NPI:1841538287
Name:LUCAS, CARRIE L (FNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:LUCAS
Suffix:
Gender:F
Credentials:FNP
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 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:1307 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOCKWOOD
Practice Address - State:MO
Practice Address - Zip Code:65682-8327
Practice Address - Country:US
Practice Address - Phone:417-232-4560
Practice Address - Fax:417-232-4611
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013001557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01159456OtherRR MCR
MO1841538287Medicaid
MO431560263OtherTRICARE
MO1841538287Medicaid