Provider Demographics
NPI:1679640809
Name:LACKEY, LISKA H (FNP)
Entity type:Individual
Prefix:
First Name:LISKA
Middle Name:H
Last Name:LACKEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MANNING DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7596
Mailing Address - Country:US
Mailing Address - Phone:919-968-2796
Mailing Address - Fax:888-330-0461
Practice Address - Street 1:590 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7596
Practice Address - Country:US
Practice Address - Phone:919-968-2796
Practice Address - Fax:888-330-0461
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0200640363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner