Individual
STEVEN T LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
1331 UNION AVE STE 1145, MEMPHIS, TN 38104-7509
(901) 866-8811
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
56320
NM
363L00000X
Nurse Practitioner
7045
TN
363LA2100X
Acute Care Nurse Practitioner
APN0000007045
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1517957
—
TN
Enumeration date
05/16/2006
Last updated
08/07/2019
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