Individual
MRS. TONYA MISCHELL LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
2210 BARRON RD STE 120, POPLAR BLUFF, MO 63901-1908
(573) 785-6536
Mailing address
2210 BARRON RD STE 120, POPLAR BLUFF, MO 63901-1908
(573) 785-6536
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2021015302
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021015302
STATE LICENSE
MO
Enumeration date
08/03/2021
Last updated
12/02/2021
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