Healthcare Provider Details

I. General information

NPI: 1790509750
Provider Name (Legal Business Name): MEREDITH ELIZABETH LOCKHART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH ELIZABETH DORN

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 30401 BOX ARMY
APO AE
09154-0401
US

IV. Provider business mailing address

UNIT 28038 BOX US
APO AE
09112-8038
US

V. Phone/Fax

Practice location:
  • Phone: 314-430-7990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number877909
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: