Van L Lackey, M.D.

Primary specialty

Medical Oncology PhysicianTaxonomy code 207RX0202X

License

06430 Issued in MS

Practice address

1227 N State St
Ste 101
Jackson, MS 39202-2002

Phone

(601) 355-2485

Fax

(601) 353-1463

NPI assigned

Jun 10, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276819200000",
    "number": "1740284389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 N STATE ST",
            "address_2": "STE 101",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022002",
            "telephone_number": "601-355-2485",
            "fax_number": "601-353-1463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 N STATE ST",
            "address_2": "STE 101",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022002",
            "telephone_number": "601-355-2485",
            "fax_number": "601-353-1463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "VAN",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2010-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MS",
            "license": "06430",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MS",
            "license": "06430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTHCARE",
            "identifier": "4285654",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00115429",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1541575",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin Taylor Labonte
• Laboratory Corporation of America Holdings
• Laboratory Corporation of America Holdings
• Lanise Cooper Lacey, N.P.
• Lauren Lacey
• Lacy M Deese, LLC (Adva)
• Wanda Lacy
• Andrew Nicolas Ladner, MD
• Brittany Galle Ladner, LPTA
• Mark Edmund Ladner, M.D.

• Medical Oncology Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Medical Oncology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; 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.