1669656468 NPI number — MRS. KEISHA DENISE LOCKHART MSN, CRNP

Table of content: MRS. KEISHA DENISE LOCKHART MSN, CRNP (NPI 1669656468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669656468 NPI number — MRS. KEISHA DENISE LOCKHART MSN, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKHART
Provider First Name:
KEISHA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, CRNP
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:
1669656468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHIDRENS HOSPITAL OF PHILADELPHIA
Provider Second Line Business Mailing Address:
100 MANOR DRIVE
Provider Business Mailing Address City Name:
CHALFONT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18914-1308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-572-7880
Provider Business Mailing Address Fax Number:
215-572-8024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHIDRENS HOSPITAL OF PHILADELPHIA
Provider Second Line Business Practice Location Address:
100 MANOR DRIVE
Provider Business Practice Location Address City Name:
CHALFONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18914-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-572-7880
Provider Business Practice Location Address Fax Number:
215-572-8024
Provider Enumeration Date:
12/28/2007

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: 363LP0200X , with the licence number:  SP009531 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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