Provider Demographics
NPI:1659267219
Name:FLUKER, GRADNETTE (LMSW)
Entity type:Individual
Prefix:
First Name:GRADNETTE
Middle Name:
Last Name:FLUKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 VALLEY RUN CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0114
Mailing Address - Country:US
Mailing Address - Phone:662-351-4678
Mailing Address - Fax:662-351-4678
Practice Address - Street 1:1281 VALLEY RUN CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0114
Practice Address - Country:US
Practice Address - Phone:662-351-4678
Practice Address - Fax:662-351-4678
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000038069253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care