Stephanie Katherine Lastra, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

5019168 Issued in NC

Practice address

201 E Academy St
Fuquay Varina, NC 27526-2248

Phone

(910) 390-0363

Fax

(315) 496-7529

NPI assigned

Nov 15, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1215702766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E ACADEMY ST",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262248",
            "telephone_number": "910-390-0363",
            "fax_number": "315-496-7529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E ACADEMY ST",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262248",
            "telephone_number": "910-390-0363",
            "fax_number": "315-496-7529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASTRA",
        "first_name": "STEPHANIE",
        "middle_name": "KATHERINE",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-15",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5019168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Holyfield Lane, MS, OTR/L
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• Kristen Labianca Langworthy, DDS
• Melissa Lara, PA-C
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• Aspyn Lee
• Mi Rim Lee, OD
• Brian Leech, DMD
• Latricia Lerma

• Psychiatric/Mental Health Nurse Practitioner in Fuquay Varina, NC
• Providers in Fuquay Varina, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.