Healthcare Provider Details

I. General information

NPI: 1255624664
Provider Name (Legal Business Name): MS. BRIANNA ELIZABETH LUKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 TATES CREEK RD APT 112
LEXINGTON KY
40517-2646
US

IV. Provider business mailing address

3543 TATES CREEK RD APT 112
LEXINGTON KY
40517-2646
US

V. Phone/Fax

Practice location:
  • Phone: 410-652-7815
  • Fax: 855-871-1240
Mailing address:
  • Phone: 410-652-7815
  • Fax: 855-871-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: