Provider Demographics
NPI:1275885444
Name:LUCKHART, ANA MARIE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIE
Last Name:LUCKHART
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 BOULEVARD 26 STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8687
Mailing Address - Country:US
Mailing Address - Phone:817-767-1625
Mailing Address - Fax:817-767-1645
Practice Address - Street 1:1604 HOSPITAL PKWY STE 507
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6933
Practice Address - Country:US
Practice Address - Phone:817-354-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122706363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX758921OtherLICENSE