Provider Demographics
NPI:1710324959
Name:LACKEY, KEYA MONIKE (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KEYA
Middle Name:MONIKE
Last Name:LACKEY
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 MARQUITA AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6175
Mailing Address - Country:US
Mailing Address - Phone:704-450-2736
Mailing Address - Fax:
Practice Address - Street 1:CATAPULT HEALTH
Practice Address - Street 2:5294 BELT LINE RD SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254
Practice Address - Country:US
Practice Address - Phone:877-373-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX835452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily