Luckett, Gwynetta Maria

Luckett, Gwynetta Maria is an individual health care provider with primary practice located at 650 Joel Dr , Fort Campbell KY 42223-5318. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Luckett, Gwynetta Maria can be contacted via phone (270) 798-8388.

Contact Information

Primary practice address
650 Joel Dr Fort Campbell KY 42223-5318
Phone: (270) 798-8388
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 35400 Tennessee

Profile Details

NPI number 1053386185
LBN Legal business name Luckett, Gwynetta Maria
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 22nd, 2006
Last updated Dec 8th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053386185 NPPES
Tennessee MEDICAID 5441880

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