Lisa Darbonne Rackley, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3672 Issued in LA

Practice address

96TH Medical Group
307 Boatner Road
Eglin Afb, FL 32542

Phone

(850) 883-9957

NPI assigned

May 31, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550620800000",
    "number": "1346687373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96TH MEDICAL GROUP",
            "address_2": "307 BOATNER ROAD, STE 113",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "32542",
            "telephone_number": "850-883-9957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96TH MEDICAL GROUP",
            "address_2": "307 BOATNER ROAD",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "32542",
            "telephone_number": "850-883-9957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACKLEY",
        "first_name": "LISA",
        "middle_name": "DARBONNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-31",
        "last_updated": "2019-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "3672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dylan Preister, IDMT
• Crystal Earl Price, PHARMD
• Micah J Price, PSY.D.
• Lewis Pulley
• Joe Lynn Purvis, LCSW
• Amanda Eitel Ramsey, IDMT
• Ronald Rasor, M.D.
• Ekeitha Redd, RDH
• Nicholas Patrick Reeder, CRNA, FNP, IPM, FARM
• Janet Aileen Reeves, APRN

• General Practice Dentistry in Eglin Afb, FL
• Providers in Eglin Afb, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.