Individual provider · Type 1 NPI

Lacey Jean Wildeboer, PA

Physician Assistant · Kenly, NC

NPI number 1477077089 Active

Practice location

400 N Englewood Dr
Kenly, NC 27542-9290

Call (919) 284-4149 Map

Fax (919) 284-6008

Mailing address

5221 Paramount Pkwy Ste 220
Morrisville, NC 27560-5490

Other practice locations

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

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000X0010-07379 (NC)

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

4 other providers at this address

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About NPI 1477077089

Lacey Jean Wildeboer, PA's National Provider Identifier is 1477077089, issued on Jul 26, 2017. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Kenly, NC. The record was last updated on Oct 3, 2025.