Healthcare Provider Details

I. General information

NPI: 1710808043
Provider Name (Legal Business Name): KAYLA ELIZABETH LACKEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MULBERRY ST SW
LENOIR NC
28645-5716
US

IV. Provider business mailing address

4914 LUNA PT
HICKORY NC
28601-9408
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-5100
  • Fax:
Mailing address:
  • Phone: 828-270-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5025024
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: