Provider Demographics
NPI:1457686925
Name:LUSKIN, GRACE KELLY (ARNP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:KELLY
Last Name:LUSKIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2404
Mailing Address - Country:US
Mailing Address - Phone:270-753-9300
Mailing Address - Fax:
Practice Address - Street 1:305 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2404
Practice Address - Country:US
Practice Address - Phone:270-753-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6267P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner