Individual
CAROL R LUCKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
120 E CHURCH ST, LEXINGTON, TN 38351
(731) 968-0146
(731) 968-9398
Mailing address
P.O BOX 11567, JACKSON, TN 38308
(731) 661-0086
(731) 660-9055
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APN5691
TN
363LP2300X
Primary Care Nurse Practitioner
Primary
APN0000005691
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000031363
MEMPHIS MANAGED CARE (TLC
TN
01
—
156102
UNISON
TN
05
—
3900686
—
TN
05
—
39006861
—
TN
01
—
4083540
TN CARE SELECT
TN
01
—
4157526
BLUE CROSS BLUE SHIELD TN
—
Enumeration date
06/12/2006
Last updated
10/12/2011
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