Provider Demographics
NPI:1699556274
Name:LUCK, JAMIE (NP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LUCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11175 E MISSISSIPPI AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3137
Mailing Address - Country:US
Mailing Address - Phone:303-797-7227
Mailing Address - Fax:303-797-8448
Practice Address - Street 1:11175 E MISSISSIPPI AVE STE 210
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3137
Practice Address - Country:US
Practice Address - Phone:303-797-7227
Practice Address - Fax:303-797-8448
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998611-NP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000223537Medicaid