Individual
KAITLYN LUCKOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-4677
Mailing address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-4677
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
208D00000X
General Practice Physician
Primary
0101283169
VA
Other
Enumeration date
05/01/2023
Last updated
08/15/2024
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