Individual
TIANA LUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6295 OLD CANTON RD APT 34B, JACKSON, MS 39211-2935
(601) 291-8872
Mailing address
6295 OLD CANTON RD APT 34B, JACKSON, MS 39211-2935
(601) 291-8872
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
919409
MS
Other
Enumeration date
01/26/2026
Last updated
01/26/2026
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