Provider Demographics
NPI:1922668615
Name:LUCKEY, SIERRA DARNETTA
Entity Type:Individual
Prefix:MS
First Name:SIERRA
Middle Name:DARNETTA
Last Name:LUCKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12606 ELMDALE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-1873
Mailing Address - Country:US
Mailing Address - Phone:313-828-9459
Mailing Address - Fax:
Practice Address - Street 1:12606 ELMDALE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1873
Practice Address - Country:US
Practice Address - Phone:313-828-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-16
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health