Individual
JEFFREY LUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9200 N CENTRAL AVE STE 2, PHOENIX, AZ 85020-2463
(480) 999-4954
(480) 999-4712
Mailing address
9200 N CENTRAL AVE STE 2, PHOENIX, AZ 85020-2463
(480) 999-4954
(480) 999-4712
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP8054
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096036
—
AZ
Enumeration date
09/30/2015
Last updated
05/05/2023
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