Healthcare Provider Details

I. General information

NPI: 1770991804
Provider Name (Legal Business Name): BOBBY GENE LUCAS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 7TH AVE S STE B2
GREAT FALLS MT
59405-3033
US

IV. Provider business mailing address

2517 7TH AVE S STE B2
GREAT FALLS MT
59405-3033
US

V. Phone/Fax

Practice location:
  • Phone: 406-952-0061
  • Fax: 855-570-2874
Mailing address:
  • Phone: 406-952-0061
  • Fax: 855-570-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-102840
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number102840
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: