Provider Demographics
NPI:1619921632
Name:LUKIN, PENNY ROSEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:ROSEN
Last Name:LUKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HUXLEY RD
Mailing Address - Street 2:STE 4
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922
Mailing Address - Country:US
Mailing Address - Phone:865-671-0780
Mailing Address - Fax:865-671-0822
Practice Address - Street 1:118 HUXLEY RD
Practice Address - Street 2:STE 4
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922
Practice Address - Country:US
Practice Address - Phone:865-671-0780
Practice Address - Fax:865-671-0822
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1816103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN173677OtherBC BS
TN3684597Medicaid
TN173677OtherBC BS