Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lacey Jean Wildeboer, PA

Individual provider Physician Assistant · NPI 1477077089

Lacey Jean Wildeboer, PA is a Physician Assistant in Kenly, North Carolina. Qualified in 2017, 9 years ago. Practices with UNC Physicians Network LLC, a 986-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in North Carolina.

Years since qualifying
9
Licensed in
NC
In the registry since
2017
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

400 N Englewood Dr
Kenly, NC 27542-9290
Phone: (919) 284-4149
Fax: (919) 284-6008
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 7201 Us Highway 64 E, Knightdale, NC 27545-9268 — (919) 266-7600

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-07379 (NC)

Record details

NPI number1477077089
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJuly 26, 2017
Last updated in NPPESOctober 3, 2025
Certification dateOctober 3, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Unc Physicians Network Llc — 986 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services