Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jacob Gray Lackey, PA-C

Individual provider Physician Assistant · NPI 1699178731

Jacob Gray Lackey, PA-C is a Physician Assistant in Clemmons, North Carolina. Qualified in 2014, 12 years ago. Practices with Appalachian Regional Medical Associates Inc, a 149-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
12
Licensed in
NC
In the registry since
2014
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3163 Gammon Ln
Clemmons, NC 27012-9052
Phone: (336) 310-5571
Fax: (336) 310-5574
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-05288 (NC)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 001005288 (NC)

Record details

NPI number1699178731
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 3, 2014
Last updated in NPPESAugust 18, 2021
Certification dateAugust 18, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Appalachian Regional Medical Associates Inc — 149 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Clemmons