DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: LACEY JEAN WILDEBOER PA

MEDICARE: LACEY JEAN WILDEBOER PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0010-07379NC

General Provider Information

NPI Number : 1477077089
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACEY JEAN WILDEBOER PA
Provider Business Mailing Address
First Line : 5221 PARAMOUNT PKWY STE 220
Second Line :
City : MORRISVILLE
State : NC
Zip : 27560-5490
Country : US
Telephone Number : 984-215-4111
Fax Number :
Provider Business Practice Location Address
First Line : 400 N ENGLEWOOD DR
Second Line :
City : KENLY
State : NC
Zip : 27542-9290
Country : US
Telephone Number : 919-284-4149
Fax Number : 919-284-6008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2017
Last Update Date : 10/03/2025

Similar Medicare Providers

1336189760 — JOHNSTON MEMORIAL HOSPITAL AUTHORITY
Practice Location Address:
400 N ENGLEWOOD DR
KENLY, NC
27542-9290
Practice Phone: 919-284-4149
Practice Fax: 919-284-6008
1295745099 — JOHNSTON MEMORIAL HOSPITAL
Practice Location Address:
400 N ENGLEWOOD DR
KENLY, NC
27542-9290
Practice Phone: 919-284-4149
Practice Fax: 919-284-6008
1578665444 — DR. DONNA MICHELLE CAPPS M.D.
Practice Location Address:
400 N ENGLEWOOD DR
KENLY, NC
27542-9290
Practice Phone: 919-284-4149
Practice Fax: 919-284-6008
1962926964 — JOSHUA SCOTT BARNES FNP-C
Practice Location Address:
400 N ENGLEWOOD DR
KENLY, NC
27542-9290
Practice Phone: 919-284-4149
Practice Fax: 919-284-6008
1376131128 — LISA CAROL NARRON FNP-C
Practice Location Address:
400 N ENGLEWOOD DR
KENLY, NC
27542-9290
Practice Phone: 919-284-4149
Practice Fax:
1548222755 — REBECCA M LANCASTER P.A.
Practice Location Address:
101 E 2ND STREET
KENLY, NC
27542
Practice Phone: 919-284-4025
Practice Fax: 919-284-5965

Directions to “ LACEY JEAN WILDEBOER PA” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.