Provider Demographics
NPI:1043201585
Name:LUKE, CELESTE CHILDRESS (MD)
Entity type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:CHILDRESS
Last Name:LUKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALEXANDRIA VA HEALTH CARE SYSTEM
Mailing Address - Street 2:2495 SHREVEPORT HIGHWAY
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4044
Mailing Address - Country:US
Mailing Address - Phone:318-473-0010
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12539R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1541184Medicaid
LA185374602OtherUNITED HEALTHCARE
LA721418139OtherSTATE GROUP BENEFITS
LA9903808OtherGEHA
LA1948691Medicaid
LA180034882OtherRAILROAD MEDICARE
LA721418139OtherHUMANA
LA5A527Medicare ID - Type Unspecified
LA9903808OtherGEHA
LA721418139OtherSTATE GROUP BENEFITS
LA1948691Medicaid