Individual
CATHERINE TALBOT LACKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6286 BRIARCREST AVE STE 200, MEMPHIS, TN 38120-4023
(901) 641-3000
(901) 259-1698
Mailing address
6077 PRIMACY PKWY STE 140, MEMPHIS, TN 38119-5742
(901) 725-8347
(901) 259-7637
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
168742
TN
363LF0000X
Family Nurse Practitioner
Primary
14930
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110318002
—
AR
05
—
3371161
—
TN
01
—
4306810
BCBS TN
TN
01
—
620819926
BCBS MS
MS
01
—
620819926
AETNA
TN
05
—
7187860
—
MS
01
—
9337653
AETNA
TN
Enumeration date
01/19/2010
Last updated
03/18/2021
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