Provider Demographics
NPI:1205916285
Name:LUCAS, KERRIE ANN-MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:ANN-MARIE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 BEAUBIEN ST # 2102
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-745-5588
Mailing Address - Fax:313-993-8738
Practice Address - Street 1:3901 BEAUBIEN ST # 2102
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5588
Practice Address - Fax:313-993-8738
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704222945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ75336Medicare UPIN