Provider Demographics
NPI:1568199297
Name:LUCAS, TRACEY LYNN (OWNER)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:MRS
Other - First Name:PROFESSIONAL HANDS
Other - Middle Name:OF
Other - Last Name:CARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:955 VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2441
Mailing Address - Country:US
Mailing Address - Phone:859-338-4571
Mailing Address - Fax:
Practice Address - Street 1:955 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2441
Practice Address - Country:US
Practice Address - Phone:859-338-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8744447530251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health