Individual
DANIEL JAMES LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1287 CREEKSHIRE WAY, WINSTON SALEM, NC 27103-3057
(336) 245-9521
(855) 308-2340
Mailing address
PO BOX 360, SYLVA, NC 28779-0360
(888) 339-6065
(828) 538-4441
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5010621
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548755432
—
NC
01
—
19YVP
BCBS NC
NC
01
—
NNG668A
MEDICARE
NC
01
—
Q00092508
RAILROAD MEDICARE
NC
Enumeration date
06/25/2018
Last updated
08/10/2023
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