Provider Demographics
NPI:1912576737
Name:CUMMINGS, LUCAS (RN)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 PETER ALAN
Mailing Address - Street 2:
Mailing Address - City:NASH
Mailing Address - State:TX
Mailing Address - Zip Code:75569-3046
Mailing Address - Country:US
Mailing Address - Phone:903-908-5108
Mailing Address - Fax:
Practice Address - Street 1:1007 S WILLIAM ST STE 5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3245
Practice Address - Country:US
Practice Address - Phone:903-796-1278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX866100163WE0003X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WE0003XNursing Service ProvidersRegistered NurseEmergency