Individual
AMY LACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1755 N MECKLENBURG AVE, SOUTH HILL, VA 23970-4080
(434) 447-3151
Mailing address
1755 N MECKLENBURG AVE, SOUTH HILL, VA 23970-4080
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024192570
VA
Other
Enumeration date
02/11/2025
Last updated
04/16/2025
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