Rachael Clark Lackey, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN224594 Issued in GA

Practice address

4681 US Highway 84 Byp W
Thomasville, GA 31792-2607

Phone

(229) 227-2936

Fax

(229) 226-2036

NPI assigned

Jan 24, 2013

Sex

Female

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 2

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CEIBAA

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.

• Primary Care of Southwest Georgia, Inc

  • Federally Qualified Health Center (FQHC)
  • Thomasville, GA
  • NPI 1952196560

  GA

  Medicare reassignment NPD
• Primary Care of Southwest Georgia, Inc.

  • Federally Qualified Health Center (FQHC)
  • Thomasville, GA
  • NPI 1366641318
  NPD

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

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507248000000",
    "number": "1780922849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 SMITH AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925535",
            "telephone_number": "229-584-2540",
            "fax_number": "229-226-2036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4681 US HIGHWAY 84 BYP W",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317922607",
            "telephone_number": "229-227-2936",
            "fax_number": "229-226-2036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "RACHAEL",
        "middle_name": "CLARK",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-24",
        "last_updated": "2017-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP9297951",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN224594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "ARNP9297951",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA LICENSE",
            "identifier": "RN224594",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shoaib Khan
• Ethan Kim, MD
• Brian Joseph Kimrey
• Kingdomcare LLC
• Ross Alan Kurland Jr., DO
• Ashley Lamb, M.ED.
• Stephanie Michelle Land, LDO
• Morgan Lane, MD
• Jennifer Langdon
• Kaycie Langston

• All providers in Thomasville, GA
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.