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NPI · 1477077089 · NPPES-sourced

Lacey Wildeboer PA

ActivePhysician Assistant
NPI Number
1477077089
Type 1 · Individual
Taxonomy Code
363A00000X
Contact
(919) 284-4149
License NC · 0010-07379
Last Updated
About 8 months ago (Oct 2025)
Enumerated 2017-07-26
Primary practice addressNC · 27542-9290
400 N Englewood DrKenly, NC 27542-9290
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About this NPIWhat this record shows.

NPI 1477077089 is registered to Lacey Wildeboer PA, a Physician Assistant practising at 400 N Englewood Dr in Kenly, North Carolina. Physician Assistant is a recognised medical specialty under the National Uniform Claim Committee (NUCC) taxonomy. Lacey Wildeboer PA has been enumerated in the National Provider Identifier (NPI) registry since 2017.

Provider type
Individual (Type 1)
Status
Active
Enumerated
2017-07-26
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Medicare enrollment

This provider holds a Medicare enrollment on file with the Provider Enrollment, Chain and Ownership System (PECOS). Each enrollment carries a public Medicare Enrollment ID (ENRLMT_ID) used by billers and intermediaries.

Practitioner

Source: CMS PECOS public enrollment file.

Insurance & acceptsHow to confirm coverage.

The National Plan and Provider Enumeration System (NPPES) registry does not include commercial insurance network data, so we cannot show which plans Lacey Wildeboer PA accepts. To confirm in-network status with your specific health plan, contact Lacey Wildeboer PA directly at (919) 284-4149.

Frequently asked

Yes. NPI 1477077089 is registered as Active in the CMS NPPES public registry and passes the Luhn check-digit validation that all 10-digit NPIs use.

Physician Assistant is a recognised medical specialty under the National Uniform Claim Committee (NUCC) taxonomy.

The CMS NPPES Public Registry at npiregistry.cms.hhs.gov is the authoritative source. FindMyNPI mirrors this dataset and refreshes monthly. For real-time verification, you can also call the provider's office at (919) 284-4149.

An individual healthcare provider has a single Type-1 NPI for life. Organisations can hold separate Type-2 NPIs per location, specialty, or sub-entity. Lacey Wildeboer PA is a Type-1 individual NPI.

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Quick facts

Provider typeIndividual
Taxonomy363A00000X
Last updated2025-10
Enumerated2017-07-26
StatusActive
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5 records · same addressOther providers at this location.

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Same specialtyOther Physician Assistant providers in North Carolina.

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Adjacent in the NPPES enumeration sequenceNPIs enumerated around this one.

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