Provider Demographics
NPI:1538605324
Name:LUKING FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:LUKING FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:LUKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-316-0707
Mailing Address - Street 1:903 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-3107
Mailing Address - Country:US
Mailing Address - Phone:812-316-0707
Mailing Address - Fax:
Practice Address - Street 1:903 N 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-3107
Practice Address - Country:US
Practice Address - Phone:812-316-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004665A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty