Provider Demographics
NPI:1457164048
Name:ACKLIN, LATISHA LASHELLE (PMHNP)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:LASHELLE
Last Name:ACKLIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 W CANAL CT STE 20
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5660
Mailing Address - Country:US
Mailing Address - Phone:720-466-1932
Mailing Address - Fax:
Practice Address - Street 1:2876 S VAUGHN WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3436
Practice Address - Country:US
Practice Address - Phone:720-629-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1000496363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty