Latrice Marie Gillis, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

404533 Issued in NY

Practice address

72 Evergreen Dr
Tonawanda, NY 14150-6402

Phone

(716) 799-2063

NPI assigned

Dec 19, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Junaid Hashim, M.D.

  • Psychiatry Physician
  • Williamsville, NY
  • NPI 1013038785
  Medicare reassignment
• Junaid Hashim MD

  • Psychiatry Physician
  • Williamsville, NY
  • NPI 1013199405
  NPD (past)

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1891407185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 EVERGREEN DR",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141506402",
            "telephone_number": "716-799-2063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 EVERGREEN DR",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141506402",
            "telephone_number": "716-799-2063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIS",
        "first_name": "LATRICE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-19",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ROBINSON",
            "affiliation": "N",
            "endpointDescription": "Surname",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "72 Evergreen Dr",
            "city": "Tonawanda",
            "state": "NY",
            "country_code": "US",
            "postal_code": "141506402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maurice M Gelia, D.P.M.
• Michael Gelz, PT DPT
• George Vasiliadis
• Chelsea Rae Gibson
• Rhonn Douglas Gilchrist, LCSW
• Frank J. Gioia, CASAC-T,M.ED.
• Samantha Glorioso
• Michael Eric Golden, PT DPT
• Poorna Sudha Goli
• Conor Vincent Gollegly

• Psychiatric/Mental Health Nurse Practitioner in Tonawanda, NY
• Providers in Tonawanda, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.