Healthcare Provider Details

I. General information

NPI: 1649678079
Provider Name (Legal Business Name): JAMIE LASCELLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PINE ST
RAPID CITY SD
57701-1669
US

IV. Provider business mailing address

1722 SPACE CT
RAPID CITY SD
57701-0557
US

V. Phone/Fax

Practice location:
  • Phone: 605-721-8939
  • Fax:
Mailing address:
  • Phone: 605-430-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP002190
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: