Provider Demographics
NPI:1447229497
Name:LUKER, KENDA M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KENDA
Middle Name:M
Last Name:LUKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENDA
Other - Middle Name:KRISTINE
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10201 HWY 16 NORTH
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-4462
Mailing Address - Country:US
Mailing Address - Phone:254-879-4910
Mailing Address - Fax:254-879-4991
Practice Address - Street 1:10201 HWY 16 NORTH
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-4462
Practice Address - Country:US
Practice Address - Phone:254-879-4910
Practice Address - Fax:254-879-4991
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2930828-01Medicaid
TX8134494Medicare ID - Type Unspecified