Individual
MR. GILBERT LYNN LUCKEL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AG-ACNP
Contact information
Practice address
101 COURTENAY CIR, HATTIESBURG, MS 39402-3176
(601) 579-5180
(601) 579-5374
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5180
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R884250
MS
363LA2100X
Acute Care Nurse Practitioner
Primary
R884250
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01001724
—
MS
Enumeration date
09/06/2014
Last updated
07/24/2020
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