Provider Demographics
NPI:1679635767
Name:LUCAS, ANNETTE M (RNC, ARNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:LUCAS
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Gender:F
Credentials:RNC, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 N EAGLE CREEK DR
Mailing Address - Street 2:NICU
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1805
Mailing Address - Country:US
Mailing Address - Phone:859-976-5778
Mailing Address - Fax:859-272-1146
Practice Address - Street 1:150 N EAGLE CREEK DR
Practice Address - Street 2:NICU
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1805
Practice Address - Country:US
Practice Address - Phone:859-976-5778
Practice Address - Fax:859-272-1146
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3038P363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78003746Medicaid