Healthcare Provider Details

I. General information

NPI: 1609574268
Provider Name (Legal Business Name): LATIERRA DESIRAE LINDSEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 FOXRIDGE DR STE 230
MISSION KS
66202-2307
US

IV. Provider business mailing address

5800 FOXRIDGE DR STE 230
MISSION KS
66202-2307
US

V. Phone/Fax

Practice location:
  • Phone: 913-404-6043
  • Fax: 913-222-1875
Mailing address:
  • Phone: 913-404-6043
  • Fax: 913-222-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2016042291
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-82028-091
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: