Jackie Luckett

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

172V00000X Issued in OR

Practice address

1500 NE Irving St
Portland, OR 97232-2243

Phone

(503) 258-4222

NPI assigned

Mar 6, 2008

Last updated

Mar 6, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204761600000",
    "number": "1497925390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 NW AUTUMNCREEK WAY APT I201",
            "city": "ALOHA",
            "state": "OR",
            "postal_code": "970068753",
            "telephone_number": "503-515-4826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 NE IRVING ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322243",
            "telephone_number": "503-258-4222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKETT",
        "first_name": "JACKIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-06",
        "last_updated": "2008-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OR",
            "license": "172V00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marc M Lucier, CRNA
• Julianna Bridget Lucisano, LCSW, CADC I
• Marissa Bonus Luck, MD
• Rachael Luck, PA
• John Joseph Lucke
• Jesse Luckett, LMT
• Lucrecia V Suarez G LCSW PC (Conexiones)
• Lynne Anne Ludeman, PMHNP
• Rachel Ludeman
• Jennifer Ludtke, ATC

• Community Health Worker in Portland, OR
• Providers in Portland, OR by specialty
• Community Health Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; 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.