Healthcare Provider Details

I. General information

NPI: 1588143580
Provider Name (Legal Business Name): HEATHER LUCAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER PERRY NP

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 02/12/2024
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BRUNSWICK ST
BYHALIA MS
38611-7000
US

IV. Provider business mailing address

230-3 GOODMAN ROAD EAST SUITE 200
SOUTHAVEN MS
38671-9604
US

V. Phone/Fax

Practice location:
  • Phone: 662-838-2163
  • Fax:
Mailing address:
  • Phone: 870-394-6591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number27404
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: