Healthcare Provider Details

I. General information

NPI: 1124094388
Provider Name (Legal Business Name): STEVEN KENNETH LACKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N JUSTICE ST
HENDERSONVILLE NC
28791-3410
US

IV. Provider business mailing address

800 N JUSTICE ST # 16
HENDERSONVILLE NC
28791-3410
US

V. Phone/Fax

Practice location:
  • Phone: 828-674-2433
  • Fax:
Mailing address:
  • Phone: 828-694-8350
  • Fax: 828-694-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31855
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: