Provider Demographics
NPI:1518046879
Name:LUCAS, KATHRYN ANN (CNM)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ANN
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 2198
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-2198
Mailing Address - Country:US
Mailing Address - Phone:928-729-5231
Mailing Address - Fax:
Practice Address - Street 1:FORT DEFIANCE PHS HOSPITAL
Practice Address - Street 2:CORNER OF RT N12 AND N7
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8770
Practice Address - Fax:928-729-8804
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM513367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02880580Medicaid
AZ840620OtherAHCCCS
NMQ09072Medicare UPIN