Provider Demographics
NPI:1922724715
Name:LUCKETT, SENITRA (BMSC)
Entity Type:Individual
Prefix:
First Name:SENITRA
Middle Name:
Last Name:LUCKETT
Suffix:
Gender:F
Credentials:BMSC
Other - Prefix:
Other - First Name:DOYOSOW
Other - Middle Name:
Other - Last Name:LUCKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BMSC
Mailing Address - Street 1:813 GLENCOVE LN
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5237
Mailing Address - Country:US
Mailing Address - Phone:504-864-9743
Mailing Address - Fax:
Practice Address - Street 1:813 GLENCOVE LN
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5237
Practice Address - Country:US
Practice Address - Phone:504-864-9743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator