Individual
ELIZABETH MARIE LUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
350 W COLUMBIA ST STE 310, EVANSVILLE, IN 47710-1782
(812) 464-9133
(812) 464-0559
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002981A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/28/2019
Last updated
12/22/2021
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