| Vicki Lackey, ANP | |
| 
					1950 45th St Ste 200, Munster, IN 46321-3958  | |
| (219) 912-3376 | |
| (219) 529-6267 | 
| Full Name | Vicki Lackey | 
|---|---|
| Gender | Female | 
| Speciality | Nurse Practitioner - Family | 
| Location | 1950 45th St Ste 200, Munster, Indiana | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1760421663 | NPI | - | NPPES | 
| 200459250 | Medicaid | IN | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 71001103 (Indiana) | Primary | 
| Entity Name | Skin Dermatology, Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1386399749 PECOS PAC ID: 5991187577 Enrollment ID: O20220728001977  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Vicki Lackey, ANP 1950 45th St Ste 200, Munster, IN 46321-3958 Ph: (219) 912-3376  | Vicki Lackey, ANP 1950 45th St Ste 200, Munster, IN 46321-3958 Ph: (219) 912-3376  | 
Konstantina Gardikiotes, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 9410 Calumet Ave Ste 101, Munster, IN 46321 Phone: 219-922-8051  | |
Jennifer Dawn Stone, PMHNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 9250 Columbia Ave Ste 2e, Munster, IN 46321 Phone: 219-595-0043 Fax: 219-237-2894  | |
Kathleen A Carlson, NURSE PRACTITIONER Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 761 45th St Ste 103, Munster, IN 46321 Phone: 219-922-3002 Fax: 219-922-3003  | |
Mrs. Amara Donella Dickerson, APN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 9410 Calumet Ave Ste 401, Munster, IN 46321 Phone: 219-922-4900 Fax: 219-836-9922  | |
Jennifer Lee Franklin, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 701 Superior Ave Ste 2700, Munster, IN 46321 Phone: 219-922-7168 Fax: 219-922-7170  | |
Olaide Avoseh,  Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 9128 Columbia Ave, Munster, IN 46321 Phone: 219-836-2730  | |
Brett Allen Milkevitch, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 7905 Calumet Ave, Munster, IN 46321 Phone: 219-836-5800 Fax: 219-836-3048  |