JACOB GRAY LACKEY (NPI# 1699178731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1699178731 |
Entity Type | Individual |
Full Name | JACOB GRAY LACKEY |
Credential | PA-C |
Practice Address |
2146 Blowing Rock Rd Boone NC 28607-6154 |
Mailing Address |
Po Box 10467 Greensboro NC 27404-0467 |
Practice Telephone | 3362506528 |
Mailing Telephone | 3362077005 |
Enumeration Date | 2014-10-03 |
Last Update Date | 2017-11-21 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363A00000X | Physician Assistant | 0010-05288 | NC | Physician Assistants & Advanced Practice Nursing Providers |
N | 363AM0700X |
Physician Assistant Specialization: Medical |
001005288 | NC | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
2146 BLOWING ROCK RD |
City | BOONE |
State | NC |
Zip Code | 28607-6154 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568592814 | Sharon Kane Stafford | Emergency Medicine | 2146 Blowing Rock Rd, Boone, NC 28607-6154 | 2007-03-06 |
1790269009 | Andrew Charles Gray | Physician Assistant | 2146 Blowing Rock Rd, Boone, NC 28607-6154 | 2018-09-21 |
1710268610 | Appalachian Regional Medical Associates, Inc. | Family Medicine | 2146 Blowing Rock Rd, Boone, NC 28607-6154 | 2011-09-06 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184261232 | Blaire E. Warren, Dds, Pllc | Clinic/Center | 142 Doctors Drive, Boone, NC 28607 | 2019-12-09 |
1073176871 | Whitney B Van Sant | Psychologist | 719-a Greenway Rd., Boone, NC 28607 | 2019-04-17 |
1710489273 | Appalachian Regional Medical Associates Inc | Internal Medicine | Appgastro - Asc, 870 State Farm Rd, Ste 102, Boone, NC 28607 | 2018-03-01 |
1891234019 | Laura Kacere | Counselor | 895 State Farm Rd Ste 507-5, Boone, NC 28607 | 2017-02-21 |
1902357320 | Innate Chiropractic - Pllc | Chiropractor | 838 State Farm Road, Ste 1, Boone, NC 28607 | 2016-10-20 |
1437519501 | David Hale Johnson | Nurse Practitioner | 169 Doctors Drive, Boone, NC 28607 | 2016-03-02 |
1639538895 | Lara Mele | Lactation Consultant, Non-RN | 180 Pine Hill Road, Boone, NC 28607 | 2016-02-16 |
1659749927 | Rachel Arledge | Counselor | 895 State Farm Rd. Bldg. 500, Ste. 505, Boone, NC 28607 | 2015-09-03 |
1346625431 | Kelly Walsh Whiteley | Dentist | 450 New Market Blvd Ste 2, Boone, NC 28607 | 2015-07-30 |
1184000234 | Ruby Amanda Stipe Blaylock | Physician Assistant | 2146 Blowing Rock Road - App Urgent Care, Boone, NC 28607 | 2015-07-30 |
Find all providers in zip 28607 |
Taxonomy Code | 363A00000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841851698 | Jillian Tremblay | Physician Assistant | 338 Deerfield Rd, Boone, NC 28607-2860 | 2019-06-24 |
1043871700 | Sarah Yoder Montgomery | Physician Assistant | 400 Shadowline Dr # 100, Boone, NC 28607-5089 | 2019-06-24 |
1134691819 | Courtney Collier | Physician Assistant | 870 State Farm Rd Ste 102, Boone, NC 28607-4862 | 2018-12-19 |
1184000234 | Ruby Amanda Stipe Blaylock | Physician Assistant | 2146 Blowing Rock Road - App Urgent Care, Boone, NC 28607 | 2015-07-30 |
1063659910 | James R Byrd | Physician Assistant | 178 Highway 105 Ext Ste 201, Boone, NC 28607-5531 | 2009-01-14 |
1023265113 | Celeste Halcomb | Physician Assistant | 579 Greenway Rd Ste 200, Boone, NC 28607-4975 | 2008-08-20 |
1396966644 | Francisco Luis Ancaya | Physician Assistant | 169 Doctors Dr, Boone, NC 28607-5017 | 2007-05-02 |
1063632503 | Jennifer Vinez Slagle | Physician Assistant | 579 Greenway Rd., Suite 200, Boone, NC 28607-4809 | 2007-04-26 |
1528001914 | Lynn Styers Gilbert | Physician Assistant | 950 State Farm Rd Ste 200, Boone, NC 28607-5021 | 2006-06-14 |
1023068624 | Cassandra Lynn Stull | Physician Assistant | Mary S Shook Student Health Services, 614 Howard St Po Office Box 32070, Boone, NC 28608-2070 | 2006-05-12 |
Find all providers in BOONE |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.