Healthcare Provider Details

I. General information

NPI: 1275113987
Provider Name (Legal Business Name): LONNIE KENT LUCAS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 4TH ST
DANVILLE WV
25053-4632
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR
HUNTINGTON WV
25701-3656
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-8839
  • Fax:
Mailing address:
  • Phone: 304-691-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35777
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: