MEDICARE: LOU RANDALL LOCKE FNP

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	363LF0000X	Family Nurse Practitioner	AP128352	TX

General Provider Information

NPI Number	:	1659741957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOU RANDALL LOCKE FNP

Provider Business Mailing Address
First Line	:	3838 W PARK AVE
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-1812
Country	:	US
Telephone Number	:	409-882-4705
Fax Number	:	409-886-5305

Provider Business Practice Location Address
First Line	:	3838 W PARK AVE
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-1812
Country	:	US
Telephone Number	:	409-882-4705
Fax Number	:	409-886-5305

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

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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Directions to “ LOU RANDALL LOCKE FNP” Practice Location

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