Provider Demographics
NPI:1073975090
Name:LACY-JUSTE, LATRICIA ANN (APRN FNP-BC PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LATRICIA
Middle Name:ANN
Last Name:LACY-JUSTE
Suffix:
Gender:F
Credentials:APRN FNP-BC PMHNP-BC
Other - Prefix:
Other - First Name:LATRICIA
Other - Middle Name:A
Other - Last Name:LACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN FNP-BC
Mailing Address - Street 1:1800 W. CHARLESTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2000
Mailing Address - Fax:
Practice Address - Street 1:1800 W. CHARLESTON BLVD.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-383-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002167363LF0000X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health