Healthcare Provider Details

I. General information

NPI: 1386577831
Provider Name (Legal Business Name): MARY ANN LUCAS BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE LUCAS

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LEXINGTON RD
VERSAILLES KY
40383-1738
US

IV. Provider business mailing address

411 MIRRORTON AVE UNIT 322
LAKELAND FL
33801-4997
US

V. Phone/Fax

Practice location:
  • Phone: 859-251-4700
  • Fax:
Mailing address:
  • Phone: 239-919-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: