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General NPI Number Information
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NPI Number | 1265575609
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Entity Type | Individual
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Provider Name | STACY LACKEY M.S.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 5635 N MARTIN LUTHER KING JR BLVD
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City | TULSA
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State | OK
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Zip | 74126-6409
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Country | US
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Telephone | 918-594-4731
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Fax | 918-595-4269
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Provider Business Mailing Address
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Address Line | 5635 N MARTIN LUTHER KING JR BLVD
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City | TULSA
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State | OK
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Zip | 74126-6409
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Country | US
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Telephone | 918-594-4731
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Fax | 918-595-4269
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 329
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License Number State | OK
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