1912932401 NPI number — MS. KAREN ANN LUCKETT OTR, CHT, CLCP, CCM

Table of content: MS. KAREN ANN LUCKETT OTR, CHT, CLCP, CCM (NPI 1912932401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912932401 NPI number — MS. KAREN ANN LUCKETT OTR, CHT, CLCP, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCKETT
Provider First Name:
KAREN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR, CHT, CLCP, CCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912932401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1263 CALLE CERRITO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93101-4906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-570-0306
Provider Business Mailing Address Fax Number:
805-898-0315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1263 CALLE CERRITO
Provider Second Line Business Practice Location Address:
SUITE 777
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93101-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-570-0306
Provider Business Practice Location Address Fax Number:
805-898-0315
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  OT5460 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013942507 . This is a "NPI FORMERLY ISSUED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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