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General NPI Number Information
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NPI Number | 1710324959
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Entity Type | Individual
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Provider Name | KEYA MONIKE LACKEY RN, MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | CATAPULT HEALTH 5294 BELT LINE RD SUITE 200
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City | DALLAS
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State | TX
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Zip | 75254
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Country | US
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Telephone | 877-373-9974
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Fax |
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Provider Business Mailing Address
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Address Line | 5740 MARQUITA AVE APT 8
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City | DALLAS
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State | TX
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Zip | 75206-6175
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Country | US
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Telephone | 704-450-2736
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 835452
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License Number State | TX
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