Provider Demographics
NPI:1508335118
Name:LUCKETT-AUSTIN, ARLETTA S
Entity Type:Individual
Prefix:
First Name:ARLETTA
Middle Name:S
Last Name:LUCKETT-AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 WIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-4437
Mailing Address - Country:US
Mailing Address - Phone:240-817-6069
Mailing Address - Fax:
Practice Address - Street 1:1669 WIGGINS RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-4437
Practice Address - Country:US
Practice Address - Phone:240-817-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care