Individual
ANDREA LEE LUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3920 DUTCHMANS LN, LOUISVILLE, KY 40207-4702
(502) 259-6710
(502) 259-6704
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1077892
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
3004813
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000477092
BLUE SHIELD
KY
01
—
0958722
RAILROAD MEDICARE
—
05
—
201363600
—
IN
01
—
2783422000
PASSPORT ADVANTAGE
KY
01
—
50014417
PASSPORT
KY
05
—
7100110260
—
KY
Enumeration date
12/05/2005
Last updated
03/01/2023
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