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NPI Code Detail

MEDICARE: KAITLYN JADE LOCKE HAS

MEDICARE: KAITLYN JADE LOCKE HAS
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
1237700000XHearing Instrument SpecialistAS5226FL

General Provider Information

NPI Number : 1205386257
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN JADE LOCKE HAS
Provider Business Mailing Address
First Line : 405 W HIGHWAY 90
Second Line :
City : BONIFAY
State : FL
Zip : 32425-2519
Country : US
Telephone Number : 850-373-7174
Fax Number :
Provider Business Practice Location Address
First Line : 2232 SAINT ANDREWS BLVD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-2158
Country : US
Telephone Number : 850-784-4327
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2016
Last Update Date : 10/13/2016

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Directions to “ KAITLYN JADE LOCKE HAS” Practice Location

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