| Doctor Name: | DAVON LACKIE |
| NPI Number: | 1063803567 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | A004220 |
| Business Practice Address: | 103 Woodlane Dr Searcy, AR - 721436113 |
| Business Phone Number: | 5012683733 |
| Business Fax Number: | |
| Mailing Address: | 103 Woodlane Dr, SEARCY |
| State: | AR |
| Postal Code: | 721436113 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2015 |
| NPI Last Update Date: | 02/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | A004220 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |