Kelly Corinne Lackey

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

093691 Issued in OH

Practice address

4148 Oxford Middletown Rd
Trenton, OH 45067-9693

Phone

(513) 312-1935

NPI assigned

Mar 16, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kelly Corinne Dunaway Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551744000000",
    "number": "1184948424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4148 OXFORD MIDDLETOWN RD",
            "city": "TRENTON",
            "state": "OH",
            "postal_code": "450679693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4148 OXFORD MIDDLETOWN RD",
            "city": "TRENTON",
            "state": "OH",
            "postal_code": "450679693",
            "telephone_number": "513-312-1935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3089 Fear Not Mills Rd",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "OH",
            "postal_code": "450119050",
            "country_code": "US",
            "telephone_number": "513-312-1935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "KELLY",
        "middle_name": "CORINNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-16",
        "last_updated": "2019-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN093691",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "093691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184948424",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DUNAWAY",
            "middle_name": "CORINNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel Evan Keltner
• Alexis King, STNA, BA ECE
• Jennifer Anne Krabbe
• Vickie Renee Kraft, LPN
• McKenzie Jane Kyde, CDCA
• Amy Elizabeth Lazear, RPH
• Ciera Denise Lockett
• Lockettincllc
• Amanda Gale Lyons
• Babita Mainali

• Licensed Practical Nurse in Trenton, OH
• Providers in Trenton, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.