1265408157 NPI number — DR. KIMBERLY KAY LOCKHART D.C.

Table of content: (NPI 1578012084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265408157 NPI number — DR. KIMBERLY KAY LOCKHART D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKHART
Provider First Name:
KIMBERLY
Provider Middle Name:
KAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265408157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
357 BAY RD
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
QUEENSBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12804-3051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-798-3237
Provider Business Mailing Address Fax Number:
518-798-3238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
357 BAY RD
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
QUEENSBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12804-3051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-798-3237
Provider Business Practice Location Address Fax Number:
518-798-3238
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X007027-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 98L254 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CO70278 . This is a "WORKER'S COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10033814 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: X59961 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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