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DR. KIM B LACKEY DNP, APRN, AGPCNP-BC
NPI 1699241752
Nurse Practitioner - Primary Care in Matthews, NC

Active since October 16, 2018PECOS Enrolled
434 N TRADE ST STE 104, MATTHEWS, NC 28105(704) 246-3936(704) 771-1931 Get Directions Write a Review

NPPES record last updated: February 26, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 22, 2020, Oct 16, 2018 (2 updates tracked since 2018).

About Dr. Kim B Lackey Dnp, Aprn, Agpcnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KIM B LACKEY DNP, APRN, AGPCNP-BC (NPI 1699241752) is an individual primary care provider in Matthews, North Carolina, licensed in North Carolina (5011316) and active in the NPI registry since October 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1699241752
Entity TypeIndividualFemale
Primary Taxonomy363LP2300X
Provider Legal NameDR. KIM B LACKEYCredential: DNP, APRN, AGPCNP-BC
Location Address434 N TRADE ST STE 104Matthews, NC 28105-1865
Mailing Address434 N Trade St Ste 104Matthews, NC 28105-1865 · (704) 246-3936 · Fax (704) 771-1931
Phone(704) 246-3936
Fax(704) 771-1931
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateOctober 16, 2018
Last NPPES UpdateFebruary 26, 20262 updates tracked since enumeration
NPPES CertifiedFebruary 26, 2026
✔ NPI 1699241752 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License✔ Licensed in NC · 5011316
Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X · License 5011316 (NC)
Also ListedNurse Practitioner · GerontologyTaxonomy 363LG0600X · License 5011316 (NC)
434 N TRADE ST STE 104, Matthews, NC 28105
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kim B Lackey Dnp, Aprn, Agpcnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8022599448
PECOS Enrollment IDI20260224003396
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 28105 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$83.90 typical visit price
range $54.12 – $165.09
Typical copayment $20.97 (range $13.53 – $41.27)
Most-billed visit code 99203
Established Patient
$95.94 typical visit price
range $17.21 – $134.61
Typical copayment $23.98 (range $4.30 – $33.65)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FORSYTH MEDICAL GROUP, LLC
Internal Medicine
434 N TRADE ST STE 104
MATTHEWS, NC 28105
Mecklenburg County (704) 246-3936

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kim Lackey's NPI number?

The NPI number for Kim Lackey is 1699241752. It was assigned to this individual provider in the NPPES registry on October 16, 2018.

Where is Kim Lackey located?

Kim Lackey practices at 434 N Trade St Ste 104, Matthews, NC 28105. The listed phone number is (704) 246-3936.

What is Kim Lackey's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Is Kim Lackey enrolled in Medicare?

Yes. Kim Lackey is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kim Lackey was last updated on February 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.