Healthcare Provider Details

I. General information

NPI: 1073975090
Provider Name (Legal Business Name): LATRICIA ANN LACY-JUSTE APRN FNP-BC PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATRICIA A LACY APRN FNP-BC

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 W POST RD STE 110
LAS VEGAS NV
89148-2429
US

IV. Provider business mailing address

5155 BLUE DIAMOND RD STE 102-207
LAS VEGAS NV
89139-7695
US

V. Phone/Fax

Practice location:
  • Phone: 702-918-7300
  • Fax: 725-241-5513
Mailing address:
  • Phone: 702-918-7300
  • Fax: 725-241-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002167
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN002167
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN002167
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: