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

Taylor Lackey

Individual provider Nurse Practitioner · NPI 1083479539

Taylor Lackey is a Nurse Practitioner in Menasha, Wisconsin. Qualified in 2024, 2 years ago. Practices with Thedacare, Incorporated, a 654-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
2
Licensed in
WI
In the registry since
2024
Specialties on file
2

Practice location Address checks out

1095 Midway Rd
Menasha, WI 54952-1115
Phone: (920) 720-2300
Show map & directions

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

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 15030 (WI)
Nurse Practitioner Taxonomy 363L00000X · Licence 15030 (WI)

Record details

NPI number1083479539
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 14, 2024
Last updated in NPPESNovember 6, 2025
Certification dateNovember 6, 2025
Mailing address3 Neenah Ctr, Neenah, WI 54956-3070

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Thedacare, Incorporated — 654 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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