Individual
JAMES M LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
200 ROUTE 98 W ST, SUITE 103, NUTTER FORT, WV 26301-4385
(304) 623-6330
(304) 623-1333
Mailing address
200 ROUTE 98 W ST, SUITE 103, NUTTER FORT, WV 26301-4385
(304) 623-6330
(304) 623-1333
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
TEMP
WV
Other
Enumeration date
10/05/2009
Last updated
10/05/2009
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