Individual
AMETHYST'AI RAIN QUINTANILLA-LUCKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1206 W MARTIN LUTHER KING ST, MUSKOGEE, OK 74401-3747
(539) 228-0449
Mailing address
1206 W MARTIN LUTHER KING ST, MUSKOGEE, OK 74401-3747
(539) 228-0449
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Enumeration date
11/25/2024
Last updated
11/25/2024
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