MEDICARE: MRS. JENNIFER LYNN LOCKHART FNP-BC

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	163W00000X	Registered Nurse	72510	WV
2	163W00000X	Registered Nurse	RN.408791-1	OH
3	163W00000X	Registered Nurse	309908	NC
4	363LF0000X	Family Nurse Practitioner	5011263	NC

General Provider Information

NPI Number	:	1497102818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN LOCKHART FNP-BC

Provider Business Mailing Address
First Line	:	109 FLORENCE DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-9285
Country	:	US
Telephone Number	:	304-482-5146
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 POWHATAN RD
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-9217
Country	:	US
Telephone Number	:	919-550-2200
Fax Number	:	919-359-2529

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

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	03/01/2019

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