MEDICARE: ADAM LUCKETTE PA-C

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	363A00000X	Physician Assistant	PA1149	NV

General Provider Information

NPI Number	:	1992947535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM LUCKETTE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 370644
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89137-0644
Country	:	US
Telephone Number	:	702-360-6003
Fax Number	:	702-360-6006

Provider Business Practice Location Address
First Line	:	7336 W POST RD STE 109
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-6647
Country	:	US
Telephone Number	:	702-369-0088
Fax Number	:	702-893-4913

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

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	09/25/2025

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Directions to “ ADAM LUCKETTE PA-C” Practice Location

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