Healthcare Provider Details

I. General information

NPI: 1194152231
Provider Name (Legal Business Name): CARISSA RENAE LUKING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 N 7TH ST
VINCENNES IN
47591-3107
US

IV. Provider business mailing address

429 PERRY ST
VINCENNES IN
47591-2127
US

V. Phone/Fax

Practice location:
  • Phone: 812-316-0707
  • Fax: 812-316-0702
Mailing address:
  • Phone: 812-494-2920
  • Fax: 812-494-2924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004665A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: