Provider Demographics
NPI:1245338839
Name:LUCAS-BUCK, JACQUELINE DENISE (FAMILY NURSE PRACTIT)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:DENISE
Last Name:LUCAS-BUCK
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:DENISE
Other - Last Name:LUCAS-BUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FAMILY NURSE PRACTIT
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:919 HIDDEN RDG
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3813
Practice Address - Country:US
Practice Address - Phone:469-282-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04696363LF0000X
TXAP116812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily