MS. LAURIE LEIGH LACKLAND


Address: 1065 Ruth St, Prescott, AZ 86301-1729
Phone: 9287785655

MS. LAURIE LEIGH LACKLAND (NPI# 1376895961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1376895961
Entity Type Individual
Full Name MS. LAURIE LEIGH LACKLAND
Credential ANP
Practice Address 1065 Ruth St
Prescott
AZ 86301-1729
Mailing Address Po Box 2104
Prescott
AZ 86302-2104
Practice Telephone 9287785655
Mailing Telephone 8055061649
Enumeration Date 2012-10-08
Last Update Date 2014-07-02
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LA2200X Nurse Practitioner
Specialization: Adult Health
AP4680 AZ Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 1065 RUTH ST
City PRESCOTT
State AZ
Zip Code 86301-1729

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NPI Name Taxonomy Address Enumeration
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Taxonomy Information

Taxonomy Code 363LA2200X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Adult Health

Taxonomy Definition

Definition to come...

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1497086474 Pamela Ann Akers Nurse Practitioner 1050 Gail Gardner Way 300, Prescott, AZ 86305-1640 2010-01-15
1164523098 Suzann L Polk Nurse Practitioner 2940 Somerset Dr, Prescott, AZ 86305-5006 2006-09-25
1487755393 Tana Bourdage-allman Nurse Practitioner Navahcs 550 North Highway 89, Prescott, AZ 86313 2006-09-25
1578671780 Debra M Hiller Nurse Practitioner Navahcs Highway 89, Prescott, AZ 86313 2006-08-28
1811907058 Bette Susan Zager Nurse Practitioner Northern Arizona Veteran Administration Health Care Sy, 500 N Hwy 89 (ecrc2), Prescott, AZ 86313 2006-08-09
1013959964 Brenda A. Austin Nurse Practitioner 3212 N. Windsong Drive, Suite 200, Prescott, AZ 86305-3700 2006-06-12
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1124208558 Lisa Santiago Nurse Practitioner 2100 Centerpointe West Dr, Prescott, AZ 86301-8487 2007-11-14
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Competitor

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City PRESCOTT
Zip Code 86301

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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