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Individual

CARRIE KELLEY LUCAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
870 S FRONT ST STE 200, CENTRAL POINT, OR 97502-2779
(541) 732-8000
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
F11230401
UT
363LF0000X
Family Nurse Practitioner
Primary
10022149
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500832248
OR
Enumeration date
12/04/2023
Last updated
04/03/2024
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