Individual
BRIAN LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
800 TILGHMAN DR, DUNN, NC 28334-5510
(919) 461-0017
Mailing address
62 PAULA DR, ANGIER, NC 27501-9029
(910) 494-0018
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
249344
NC
363L00000X
Nurse Practitioner
Primary
LACK-V9WF0
NC
Other
Enumeration date
11/02/2022
Last updated
11/02/2022
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