MEDICARE: KIRBY LOCKETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1043847551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRBY LOCKETT

Provider Business Mailing Address
First Line	:	5132 W MILL RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-1302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5132 W MILL RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-1302
Country	:	US
Telephone Number	:	414-949-6021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	03/25/2020

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Directions to “ KIRBY LOCKETT ” Practice Location

Language	Start Address	Practice Location

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