Provider Demographics
NPI:1710058003
Name:THOMAS, XYLDIA LUCKEY (APRN, WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:XYLDIA
Middle Name:LUCKEY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71408 NIGHTWALK LN
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3746
Mailing Address - Country:US
Mailing Address - Phone:985-778-8170
Mailing Address - Fax:985-898-5005
Practice Address - Street 1:377 HIGHWAY 21 STE 101
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3442
Practice Address - Country:US
Practice Address - Phone:985-845-4111
Practice Address - Fax:985-845-4004
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN079714363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B253C486Medicare ID - Type Unspecified
LAS95897Medicare UPIN