Kim B Lackey, DNP, APRN, AGPCNP-BC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

5011316 Issued in NC

Practice address

434 N Trade St Ste 104
Matthews, NC 28105-1865

Phone

(704) 246-3936

Fax

(704) 771-1931

NPI assigned

Oct 16, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Complexcare Medical Group Midwest M PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1528851607

  NC

  Medicare reassignment NPD
• Forsyth Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Hendersonville, NC
  • NPI 1750081378
  Medicare reassignment
• Forsyth Medical Group LLC

  • Otolaryngology Physician
  • Monroe, NC
  • NPI 1710866405
  NPD
• Forsyth Medical Group, LLC

  • Internal Medicine Physician
  • Matthews, NC
  • NPI 1194538611
  NPD

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

{
    "created_epoch": "1539648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772064000000",
    "number": "1699241752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 N TRADE ST STE 104",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281051865",
            "telephone_number": "704-246-3936",
            "fax_number": "704-771-1931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 N TRADE ST STE 104",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281051865",
            "telephone_number": "704-246-3936",
            "fax_number": "704-771-1931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "KIM",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DNP, APRN, AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-16",
        "last_updated": "2026-02-26",
        "certification_date": "2026-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NC",
            "license": "5011316",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5011316",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "5011316",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laboratory Corporation of America Holdings
• Laboratory Corporation of America Holdings
• Laboratory Corporation of America Holdings
• Laboratory Corporation of America Holdings
• Laced by Shea Inc.
• Susan E Ladd-Snively, M.D.
• Jeffrey Laforge, MSW, LCSW
• Towanda Lagrone
• Merideth Courtney Lahoud, NP
• Alex Lai, CNP

• Primary Care Nurse Practitioner in Matthews, NC
• Providers in Matthews, NC by specialty
• Primary Care Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.