MEDICARE: AMY RENEE LOCKE ACNPC-AG

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	363L00000X	Nurse Practitioner	842522	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	15226548	OTHER		CAQH

General Provider Information

NPI Number	:	1518537794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY RENEE LOCKE ACNPC-AG

Provider Business Mailing Address
First Line	:	5437 KIETZKE LN
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-1088
Country	:	US
Telephone Number	:	775-322-4550
Fax Number	:	775-322-4956

Provider Business Practice Location Address
First Line	:	2345 E PRATER WAY STE 102
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89434-9664
Country	:	US
Telephone Number	:	775-322-4550
Fax Number	:	775-332-4956

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

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	05/12/2026

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