MEDICARE: ANA MARIE LUCKHART APRN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP122706	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	758921	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1275885444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA MARIE LUCKHART APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	5750 RUFE SNOW DR STE 139
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6167
Country	:	US
Telephone Number	:	817-767-1625
Fax Number	:	817-767-1645

Provider Business Practice Location Address
First Line	:	5750 RUFE SNOW DR STE 139
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6167
Country	:	US
Telephone Number	:	817-767-1625
Fax Number	:	817-767-1645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	06/17/2026

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