Healthcare Provider Details

I. General information

NPI: 1730541160
Provider Name (Legal Business Name): MORGON LOCKWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 BAKER STREET
ST.MICHAEL AK
99659-0094
US

IV. Provider business mailing address

94 BAKER STREET
ST.MICHAEL AK
99659
US

V. Phone/Fax

Practice location:
  • Phone: 907-923-3311
  • Fax: 907-923-2287
Mailing address:
  • Phone: 907-923-3311
  • Fax: 907-923-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCHA
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerCHA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: