Provider Demographics
NPI:1043873698
Name:ROBINSON, LUCKY (APRN, AGPC-NP-C)
Entity Type:Individual
Prefix:
First Name:LUCKY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:APRN, AGPC-NP-C
Other - Prefix:
Other - First Name:LUCKY
Other - Middle Name:
Other - Last Name:KEONAVONG-ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, AGPC-NP-C
Mailing Address - Street 1:PO BOX 81093
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-1093
Mailing Address - Country:US
Mailing Address - Phone:602-492-2887
Mailing Address - Fax:
Practice Address - Street 1:13430 N SCOTTSDALE RD STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4058
Practice Address - Country:US
Practice Address - Phone:623-334-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225067363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health