Basic Information
| Provider Information | |||||||||
| NPI: | 1710361860 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURLESON ALMEIDA | ||||||||
| FirstName: | LACY | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PMHNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BURLESON | ||||||||
| OtherFirstName: | LACY | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 21444 CARMEAN WAY | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199474572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028551233 | ||||||||
| FaxNumber: | 8556349302 | ||||||||
| Practice Location | |||||||||
| Address1: | 21444 CARMEAN WAY | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199474572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028551233 | ||||||||
| FaxNumber: | 3028552025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2015 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 803366 | CA | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 95003937 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | L8-0010301 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.