Healthcare Provider Details

I. General information

NPI: 1710343108
Provider Name (Legal Business Name): KATIE ANN CUPP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE ANN LAFORGE

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 N TOWN CENTER DR STE 604
LAS VEGAS NV
89144-0520
US

IV. Provider business mailing address

400 N STEPHANIE ST STE 300
HENDERSON NV
89014-6692
US

V. Phone/Fax

Practice location:
  • Phone: 702-737-5864
  • Fax: 702-737-6885
Mailing address:
  • Phone: 702-952-3350
  • Fax: 702-952-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002090
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN002090
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: