Provider Demographics
NPI:1265989149
Name:LUCKENBILL, MARGARET (NP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:LUCKENBILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:502-775-1211
Mailing Address - Fax:502-398-0041
Practice Address - Street 1:1918 HIKES LN STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2598
Practice Address - Country:US
Practice Address - Phone:502-473-4067
Practice Address - Fax:502-473-4077
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-014339363L00000X
KY3013671363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner