Provider Demographics
NPI:1922898113
Name:GENTLEEAR GERIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:GENTLEEAR GERIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-253-8543
Mailing Address - Street 1:4755 SHIRA DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5996
Mailing Address - Country:US
Mailing Address - Phone:901-673-9944
Mailing Address - Fax:901-425-9884
Practice Address - Street 1:2552 POPLAR AVE STE 4F
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3834
Practice Address - Country:US
Practice Address - Phone:901-673-9944
Practice Address - Fax:901-425-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty