Provider Demographics
NPI:1437353786
Name:LUCKETT, JAMES ROY (APRN-BC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROY
Last Name:LUCKETT
Suffix:
Gender:M
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:FERRIS
Mailing Address - State:TX
Mailing Address - Zip Code:75125-4003
Mailing Address - Country:US
Mailing Address - Phone:972-842-3985
Mailing Address - Fax:
Practice Address - Street 1:1701 W MARSHALL DR
Practice Address - Street 2:MED00
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-2704
Practice Address - Country:US
Practice Address - Phone:972-603-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily