| NPI | 1730118431 |
|---|---|
| Former Name | NICOLE LACKEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 21324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 39860) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2022-08-18 |