Provider Demographics
NPI:1780197426
Name:LUCKETT, REBECCA SHERRILL (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SHERRILL
Last Name:LUCKETT
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:SHERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1874 BELTLINE RD SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-5514
Mailing Address - Country:US
Mailing Address - Phone:569-736-6722
Mailing Address - Fax:
Practice Address - Street 1:1872 BELTLINE ROAD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603
Practice Address - Country:US
Practice Address - Phone:615-973-6672
Practice Address - Fax:256-973-6673
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23525363L00000X, 363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care