Kimberly G Luckman, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN285427 Issued in GA

Practice address

505 Jenkins St
Lagrange, GA 30240-4225

Phone

(706) 407-0161

Fax

(706) 756-1404

NPI assigned

Oct 29, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1477197812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 JENKINS ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404225",
            "telephone_number": "706-407-0161",
            "fax_number": "706-756-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 JENKINS ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404225",
            "telephone_number": "706-407-0161",
            "fax_number": "706-756-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKMAN",
        "first_name": "KIMBERLY",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN285427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Health Nurse Practitioner in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.