Active NPI
Latisha Wormely, CNS, LDN
- Nutritionist
- Las Vegas, NV
National Provider Identifier
1700575602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- DX6087
- Practice address
- 400 S 4TH St Ste 500
Las Vegas, NV 89101-6207 - Phone
- (702) 708-1686
- NPI assigned
- May 5, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | DX6087 | MD | Primary |
Addresses
Primary practice location
400 S 4TH St Ste 500
Las Vegas, NV 89101-6207
Mailing address
200 Quail Run
Goldsboro, NC 27530-9250
Phone (623) 512-9236
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DX6087 | MD | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683244800000",
"number": "1700575602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 QUAIL RUN",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275309250",
"telephone_number": "623-512-9236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 S 4TH ST STE 500",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891016207",
"telephone_number": "702-708-1686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WORMELY",
"first_name": "LATISHA",
"credential": "CNS, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-05",
"last_updated": "2023-05-05",
"certification_date": "2023-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "MD",
"license": "DX6087",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.