Individual
DIANA LYNN LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
201 ABRAHAM FLEXNER WAY STE 905, LOUISVILLE, KY 40202-3803
(502) 587-4267
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 587-4267
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01064153A
IN
174400000X
Specialist
33011
GA
207R00000X
Internal Medicine Physician
01064153A
IN
207R00000X
Internal Medicine Physician
Primary
TP230
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200874290
—
IN
01
—
256840024
MEDICARE PTAN
IN
05
—
7100657170
—
KY
Enumeration date
02/08/2007
Last updated
03/06/2024
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