Active NPI
Latasha Deanne Myrieckes, APRN
- Family Nurse Practitioner
- Pueblo, CO
National Provider Identifier
1902376312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- APN0994336NP
- Practice address
- 4776 Eagleridge Cir
Pueblo, CO 81008-2189 - Phone
- (719) 553-1000
- NPI assigned
- Nov 28, 2018
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APN0994336NP | CO | Primary |
Addresses
Primary practice location
4776 Eagleridge Cir
Pueblo, CO 81008-2189
Mailing address
1150 Lords Hill Dr
Fountain, CO 80817-6601
Phone (719) 322-5460
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200420000504 | CO | Order and Referring Only - Nurse Practitioner | 1557791373 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN0994336NP | CO | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543363200000",
"number": "1902376312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1150 LORDS HILL DR",
"city": "FOUNTAIN",
"state": "CO",
"postal_code": "808176601",
"telephone_number": "719-322-5460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4776 EAGLERIDGE CIR",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082189",
"telephone_number": "719-553-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYRIECKES",
"first_name": "LATASHA",
"middle_name": "DEANNE",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-28",
"last_updated": "2018-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CO",
"license": "APN0994336NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.