Provider Demographics
NPI:1164713897
Name:LACKEY, RACHEL (RN)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:
Last Name:LACKEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 JUNIOR COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-2658
Mailing Address - Country:US
Mailing Address - Phone:832-392-4835
Mailing Address - Fax:
Practice Address - Street 1:2515 JUNIOR COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-2658
Practice Address - Country:US
Practice Address - Phone:832-392-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251565163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse