Provider Demographics
NPI:1619938974
Name:LACKNEY, TODD FRANCIS (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:FRANCIS
Last Name:LACKNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0990
Mailing Address - Country:US
Mailing Address - Phone:859-239-2360
Mailing Address - Fax:859-238-9760
Practice Address - Street 1:105 PONDER CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9050
Practice Address - Country:US
Practice Address - Phone:859-236-4216
Practice Address - Fax:859-238-9760
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64034796Medicaid
KY64034796Medicaid
KY0678001Medicare ID - Type Unspecified