Provider Demographics
NPI:1952345662
Name:LUCKER, CHRISTINE V (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:V
Last Name:LUCKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 PINECROFT DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3223
Mailing Address - Country:US
Mailing Address - Phone:281-943-2790
Mailing Address - Fax:281-210-2858
Practice Address - Street 1:9305 PINECROFT DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3223
Practice Address - Country:US
Practice Address - Phone:281-943-2790
Practice Address - Fax:281-210-2858
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00737363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181765201Medicaid
TX85N935Medicare PIN