Individual
MRS. ANTONETTE LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
136 E ASH ST, JACKSON, MS 39202-2217
(601) 352-6507
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6270
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R860519
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04535731
—
MS
01
—
253418
MEDICARE RURAL HEALTH
MS
Enumeration date
03/23/2006
Last updated
03/26/2010
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