=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902753296
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN J LUKENS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2026
-----------------------------------------------------
Last Update Date | 03/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 USSERY RD
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37043-4530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-647-0269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 MONKS RD LOT 14
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37334-8006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-332-8405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 41380
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------