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Licensee Information

Jacob Gray Lackey - PA-C
0010-05288
Active
No
09/24/2014
12/15/2026

Active Supervisor

NameTypeStatusApprovedInactive
Anderson, Steven Robert, MD MD Active 07/22/2024
Zimmerman, Laura Ida, MD MD Active 11/29/2017

North Carolina Hospital Admitting Privileges

Location
Charles A. Cannon, Jr. Memorial Hospital, Incorporated
Watauga Medical Center

Out of State Active/Inactive Licenses

State
None Reported

Out of Country Active/Inactive Licenses

Country
None Reported
Information loaded from this database is current as of 5/13/2026 4:09:04 PM
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