| Doctor Name: | LACOSTA GAINES |
| NPI Number: | 1003287848 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, APRN, FNP-C |
| License Number: | 2015035184 |
| Business Practice Address: | 1607 South Baltimore Kirksville, MO - 63501 |
| Business Phone Number: | 6607851000 |
| Business Fax Number: | |
| Mailing Address: | 800 W Jefferson St, KIRKSVILLE |
| State: | MO |
| Postal Code: | 635011443 |
| Phone Number: | 6606273363 |
| Fax Number: | |
| NPI Enumeration Date: | 10/19/2015 |
| NPI Last Update Date: | 10/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2015035184 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |