Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9477 | KY |
NPI | 1003224833 |
---|---|
Provider Name | Stephanie N Luckett |
First Address | Louisville, KY 40242-3214 |
Second Address | Louisville, KY 40212-1033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2014 |
Last Update Date | 06/08/2016 |