1932065695 NPI number — NICKAYLA MAESY LOCKE

Table of content: NICKAYLA MAESY LOCKE (NPI 1932065695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932065695 NPI number — NICKAYLA MAESY LOCKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKE
Provider First Name:
NICKAYLA
Provider Middle Name:
MAESY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1932065695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6002 FM 2445 RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAVASOTA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77868-7510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-450-6299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 SCOTT AND WHITE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE STATION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77845-6419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-207-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2025

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: 390200000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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