KENNETH R LUCKAY (NPI# 1770572331) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770572331 |
| Entity Type | Individual |
| Full Name | KENNETH R LUCKAY |
| Credential | DO |
| Practice Address |
4515 Brambleton Ave Suite B Roanoke VA 24018-3436 |
| Practice Telephone | 5407776807 |
| Practice Fax Number | 8552489858 |
| Mailing Telephone | 5407776807 |
| Mailing Fax Number | 8552489858 |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2014-04-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 0102049893 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | ANTHEM | 441414 | 01 |
| VA | DEPT OF LABOR | 362206700 | 01 |
| VA | 005615127 | 05 |
| Street Address |
4515 BRAMBLETON AVE SUITE B |
| City | ROANOKE |
| State | VA |
| Zip Code | 24018-3436 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497181101 | Betty C Etzler | Social Worker | 4515 Brambleton Ave, Ste B, Roanoke, VA 24018-3436 | 2013-09-26 |
| 1821310418 | Paula Marie Bell | Occupational Therapist | 4515 Brambleton Ave, Roanoke, VA 24018-3436 | 2010-02-23 |
| 1023330123 | Shelly Basham | Speech-Language Pathologist | 4515 Brambleton Ave, Roanoke, VA 24018-3436 | 2010-02-17 |
| 1457689465 | Sherri Lyn Sanders | Physical Therapist | 4515 Brambleton Ave, Roanoke, VA 24018-3436 | 2009-12-02 |
| 1881929438 | Christine L Buyer | Speech-Language Pathologist | 4515 Brambleton Ave, Roanoke, VA 24018-3436 | 2009-10-14 |
| 1700119096 | Amy Baber Boykin | Occupational Therapist | 4515 Brambleton Ave, Roanoke, VA 24018-3436 | 2009-09-17 |
| 1619200268 | Sandra L Parson | Speech-Language Pathologist | 4515 Brambleton Ave, Roanoke, VA 24018-3436 | 2009-09-15 |
| 1770731903 | Lindsay Anne Burgess | Speech-Language Pathologist | 4515 Brambleton Ave, Roanoke, VA 24018-3436 | 2008-08-29 |
| 1801068408 | Janice M Devoll | Speech-Language Pathologist | 4515 Brambleton Ave, Roanoke, VA 24018-3436 | 2008-03-24 |
| 1295919454 | Melinda L Luckay | Nurse Practitioner | 4515 Brambleton Ave, Suite B, Roanoke, VA 24018-3436 | 2007-12-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770140253 | Luz Dione Carr | Nurse Practitioner | 1934 Maple Leaf Drive, Roanoke, VA 24018 | 2019-05-21 |
| 1467926527 | Embrace Foster Care, LLC | Foster Care Agency | 3912 Electric Road, Building C, Roanoke, VA 24018 | 2019-01-11 |
| 1174005417 | Roanoke Valley Ent & Allergy PC | Otolaryngology | 2154 Mcvitty Rd, Second Floor, Roanoke, VA 24018 | 2018-09-04 |
| 1265928535 | Jane Willis Warner | Behavior Technician | 3243 Electric Road Building E Suite 1b, Roanoke, VA 24018 | 2018-07-10 |
| 1821584640 | Anchor To Hope Counseling LLC | Counselor | 4370 Starkey Rd Ste 4c-1, Roanoke, VA 24018 | 2018-07-04 |
| 1164938619 | Aurora Domangue | Behavior Technician | 3243 Electric Road, Building E Suite 1b, Roanoke, VA 24018 | 2017-12-20 |
| 1376059089 | Maggie Marie Ridgeway | Behavior Technician | 3243 Electric Rd., Building E Suite 1b, Roanoke, VA 24018 | 2017-12-18 |
| 1700301850 | Nicole Graboski | Speech-Language Pathologist | 4920 Woodmar Drive Sw, Roanoke, VA 24018 | 2017-08-10 |
| 1891215893 | Kimberly Anne Rosenberger | Occupational Therapy Assistant | 2772 Hillbrook Dr., Roanoke, VA 24018 | 2017-06-21 |
| 1083158950 | Encompass Home Health of Roanoke, LLC | Home Health | 5115 Bernard Drive, Suite 205, Roanoke, VA 24018 | 2016-12-13 |
| Find all providers in zip 24018 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083247555 | Lisa R Zettler | Family Medicine | 1016 Primrose Ave Se, Roanoke, VA 24014-2508 | 2020-02-12 |
| 1316581366 | Dustin Powers | Family Medicine | 3347 Pamlico Dr, Roanoke, VA 24018-4938 | 2019-11-03 |
| 1932692365 | Sarah Rebecca Childress | Family Medicine | 102 Highland Ave Se Ste 303, Roanoke, VA 24013-2253 | 2018-06-11 |
| 1013327188 | The Center for Ultra Health LLC | Family Medicine | 4235 Colonial Ave, First Floor, Roanoke, VA 24018-4002 | 2014-04-29 |
| 1679904338 | Mazen Madhoun Md LLC | Family Medicine | 6002 Winnbrook Ln, Roanoke, VA 24018-7907 | 2013-12-06 |
| 1245563519 | Valley Gericare Inc | Family Medicine | 1205 Moorman Ave Nw, Roanoke, VA 24017-5739 | 2009-09-17 |
| 1003149915 | Valley Gericare Inc | Family Medicine | 2917 Penn Forest Blvd, Ste 518, Roanoke, VA 24018-4374 | 2009-09-09 |
| 1679774582 | Beau James Ellenbecker | Family Medicine | 610 E Byron Nelson Blvd, Suite 101, Roanoke, TX 76262-6541 | 2007-05-29 |
| 1962535278 | Jeffrey Brad Griffin | Family Medicine | 509 E Byron Nelson Blvd, Suite B, Roanoke, TX 76262-6183 | 2007-03-14 |
| 1043349384 | Janet Lee Spitzer | Family Medicine | 1901 Denniston Ave Sw, Roanoke, VA 24015-2023 | 2007-03-04 |
| Find all providers in ROANOKE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.