Individual
GWYNETTA MARIA LUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8388
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8400
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35400
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5441880
—
TN
Enumeration date
02/22/2006
Last updated
05/28/2025
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