Provider Demographics
NPI:1609502921
Name:LYTHGOE, STACEY J (APRN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:J
Last Name:LYTHGOE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 N STEPHANIE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6692
Mailing Address - Country:US
Mailing Address - Phone:702-952-3350
Mailing Address - Fax:702-952-3364
Practice Address - Street 1:2460 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2648
Practice Address - Country:US
Practice Address - Phone:702-822-2000
Practice Address - Fax:702-938-2232
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV852457363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner