Healthcare Provider Details

I. General information

NPI: 1972203362
Provider Name (Legal Business Name): LUKE STANLEY PLUCHECK MSN, APRN, CPNP-AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 MEDICAL DR STE 550
SAN ANTONIO TX
78229-3755
US

IV. Provider business mailing address

4410 MEDICAL DR STE 550
SAN ANTONIO TX
78229-3755
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-7870
  • Fax: 210-575-6131
Mailing address:
  • Phone: 210-575-7870
  • Fax: 210-575-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number936274
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1113743
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1113743
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1113743
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: