1750407342 NPI number — MS. KAREN ANN LOCKHART

Table of content: MS. KAREN ANN LOCKHART (NPI 1750407342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750407342 NPI number — MS. KAREN ANN LOCKHART

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKHART
Provider First Name:
KAREN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
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:
REED
Provider Other First Name:
KAREN
Provider Other Middle Name:
ANN LOCKHART
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750407342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1257
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAINIER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98576-1257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-446-7113
Provider Business Mailing Address Fax Number:
360-446-0069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12445 118TH AVE SE
Provider Second Line Business Practice Location Address:
MOBILE BUISNESS OFFICE
Provider Business Practice Location Address City Name:
RAINIER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98576-9792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-446-7113
Provider Business Practice Location Address Fax Number:
360-446-0069
Provider Enumeration Date:
03/22/2007

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: 124Q00000X , with the licence number:  DH00001600 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5900675 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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