Provider Demographics
NPI:1861458796
Name:LUCKEY, PATRICIA K (ARNP/CNS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:K
Last Name:LUCKEY
Suffix:
Gender:F
Credentials:ARNP/CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 N CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8100
Mailing Address - Country:US
Mailing Address - Phone:509-734-2092
Mailing Address - Fax:509-734-1481
Practice Address - Street 1:732 N CENTER PKWY
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8100
Practice Address - Country:US
Practice Address - Phone:509-734-2092
Practice Address - Fax:509-734-1481
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005296101YM0800X, 363LP0808X
WARN0005818163WP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9626185Medicaid
WAAB14712Medicare ID - Type UnspecifiedMEDICARE