Individual
KEISHA PRUITT LUCKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2500 N STATE ST, 2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 984-5682
(601) 815-3672
Mailing address
2254 WOODLAND PL, FLORENCE, MS 39073-9771
(601) 421-9291
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
R863378
MS
Other
Enumeration date
01/06/2016
Last updated
01/06/2016
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