Provider Demographics
NPI:1285385021
Name:AREGHAN, LUCKY EHIMUOHU (FNP)
Entity type:Individual
Prefix:
First Name:LUCKY
Middle Name:EHIMUOHU
Last Name:AREGHAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 INDIAN SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4153
Mailing Address - Country:US
Mailing Address - Phone:601-506-5537
Mailing Address - Fax:
Practice Address - Street 1:CHOCTAW HEALTH CENTER
Practice Address - Street 2:210 HOSPITAL CIRCLE
Practice Address - City:CHOCTAW
Practice Address - State:MS
Practice Address - Zip Code:39350
Practice Address - Country:US
Practice Address - Phone:601-389-4463
Practice Address - Fax:601-389-4462
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily